Provider Demographics
NPI:1497137319
Name:JESCHKE, JEFFREY DALE
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DALE
Last Name:JESCHKE
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 1:8583 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-9035
Mailing Address - Country:US
Mailing Address - Phone:269-240-8711
Mailing Address - Fax:
Practice Address - Street 1:8583 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-9035
Practice Address - Country:US
Practice Address - Phone:269-240-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other