Provider Demographics
NPI:1508805490
Name:JASZCZAK, TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:JASZCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 E MAPLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6106
Mailing Address - Country:US
Mailing Address - Phone:248-524-9085
Mailing Address - Fax:248-524-9086
Practice Address - Street 1:2891 E MAPLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6106
Practice Address - Country:US
Practice Address - Phone:248-524-9085
Practice Address - Fax:248-524-9086
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M03850002OtherMEDICARE INDIVIDUAL PIN
MI101962615Medicaid
MI101962615Medicaid
MI0N31900Medicare PIN
MIE21693Medicare UPIN
MI0M03850Medicare PIN