Provider Demographics
NPI:1275507493
Name:JASKOWSKI-LUTSIC, MARGARET ANNE (MS, DO, FACOOG)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANNE
Last Name:JASKOWSKI-LUTSIC
Suffix:
Gender:F
Credentials:MS, DO, FACOOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14450 KING RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7939
Mailing Address - Country:US
Mailing Address - Phone:734-479-2100
Mailing Address - Fax:734-479-2199
Practice Address - Street 1:14450 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7939
Practice Address - Country:US
Practice Address - Phone:734-479-2100
Practice Address - Fax:734-479-2199
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF67832Medicare UPIN