Provider Demographics
NPI:1083367361
Name:XYZ PLLC
Entity Type:Organization
Organization Name:XYZ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-501-1223
Mailing Address - Street 1:111 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1543
Mailing Address - Country:US
Mailing Address - Phone:269-781-5563
Mailing Address - Fax:
Practice Address - Street 1:111 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1543
Practice Address - Country:US
Practice Address - Phone:269-781-5563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental