Provider Demographics
NPI:1124018296
Name:KRASNICK, JANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:KRASNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:E
Other - Last Name:LUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31730 HOOVER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-1700
Mailing Address - Country:US
Mailing Address - Phone:586-268-9222
Mailing Address - Fax:568-268-9226
Practice Address - Street 1:37130 HOOVER RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-268-9222
Practice Address - Fax:586-268-9226
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067218207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI030500426OtherBCN
MI4450085Medicaid
MI030005365OtherRAILROAD MEDICARE
MI030500426OtherBCBS
MIG39644OtherHAP
MIG39644OtherHAP
G39644Medicare UPIN