Provider Demographics
NPI:1326230012
Name:GIRLS JUST WANNA HAVE FUN, PLLC
Entity Type:Organization
Organization Name:GIRLS JUST WANNA HAVE FUN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-631-4545
Mailing Address - Street 1:4800 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2953
Mailing Address - Country:US
Mailing Address - Phone:989-631-4545
Mailing Address - Fax:989-631-9949
Practice Address - Street 1:4800 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2953
Practice Address - Country:US
Practice Address - Phone:989-631-4545
Practice Address - Fax:989-631-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty