Provider Demographics
NPI:1508864174
Name:JANESKI, HOLLE J (DO)
Entity Type:Individual
Prefix:DR
First Name:HOLLE
Middle Name:J
Last Name:JANESKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18580 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7442
Mailing Address - Country:US
Mailing Address - Phone:734-479-8800
Mailing Address - Fax:734-283-4861
Practice Address - Street 1:18580 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7442
Practice Address - Country:US
Practice Address - Phone:734-479-8800
Practice Address - Fax:734-283-4861
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG84067Medicare UPIN
MI3106001Medicare PIN