Provider Demographics
NPI:1477306926
Name:DENKIEWICZ, JAKUB
Entity Type:Individual
Prefix:
First Name:JAKUB
Middle Name:
Last Name:DENKIEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 MADISON AVE UNIT 2412
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3239
Mailing Address - Country:US
Mailing Address - Phone:901-340-3095
Mailing Address - Fax:
Practice Address - Street 1:397 MADISON AVE UNIT 2412
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3239
Practice Address - Country:US
Practice Address - Phone:901-340-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program