Provider Demographics
NPI:1477523892
Name:UZANSKY, JERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:UZANSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4771 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-3247
Mailing Address - Country:US
Mailing Address - Phone:313-897-2600
Mailing Address - Fax:313-897-2424
Practice Address - Street 1:4771 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-3247
Practice Address - Country:US
Practice Address - Phone:313-897-2600
Practice Address - Fax:313-897-2424
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGU005238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01030002OtherMEDICARE INDIVIDUAL #S
MI1117993Medicaid
MI0258220204OtherBCBS NUMBER
MI0P01030OtherMEDICARE GROUP NUMBER
MI1477523892OtherNPI INDIVIDUAL
MI1285813154OtherNPI GROUP NUMBER
MI5822020Medicare ID - Type UnspecifiedMEDICARE NUMBER
MI0P01030OtherMEDICARE GROUP NUMBER