Provider Demographics
NPI:1477540391
Name:MESSERSCHMIDT, JANET M (D O)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:MESSERSCHMIDT
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2700
Mailing Address - Country:US
Mailing Address - Phone:231-932-4903
Mailing Address - Fax:231-935-0613
Practice Address - Street 1:224 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2700
Practice Address - Country:US
Practice Address - Phone:231-932-4903
Practice Address - Fax:231-935-0613
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4231928Medicaid
MI4231928Medicaid
MIG77410Medicare UPIN