Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301403488 | MI |
N | 208600000X | Surgeon | 4301403488 | MI |
N | 2082S0105X | Plastic Hand Surgeon | 4301403488 | MI |
NPI | 1306909924 |
---|---|
Provider Name | Pete K. Janevski |
First Address | Dearborn, MI 48126 |
Second Address | Dearborn, MI 48126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A79260 | (02) | |
PJ403488 | CHAMPUS-CHAMPUS (01) | |
PJ403488 | COMMERCIAL-COMMERCIAL NUMBER (01) |