Provider Demographics
NPI:1053480947
Name:IGNACZAK, THOMAS F (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:IGNACZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 FREMONT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3398
Mailing Address - Country:US
Mailing Address - Phone:269-969-6123
Mailing Address - Fax:269-969-6122
Practice Address - Street 1:363 FREMONT ST STE 203
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3398
Practice Address - Country:US
Practice Address - Phone:269-969-6123
Practice Address - Fax:269-969-6122
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITI035364207RR0500X
MI4301035364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1101301121OtherBCBS
MI3199719Medicaid
MI3199719Medicaid
MI1101301121OtherBCBS