Provider Demographics
NPI:1417446394
Name:PIASECKI, ALEXANDER (NP-C)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:PIASECKI
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15801 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2021
Mailing Address - Country:US
Mailing Address - Phone:313-320-2120
Mailing Address - Fax:
Practice Address - Street 1:15801 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2021
Practice Address - Country:US
Practice Address - Phone:313-320-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily