Provider Demographics
NPI:1619040276
Name:REGALSKI, JOHN G (PAC PHYSICIAN ASST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:REGALSKI
Suffix:
Gender:M
Credentials:PAC PHYSICIAN ASST
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Mailing Address - Street 1:264 W MAPLE
Mailing Address - Street 2:#200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-273-9930
Mailing Address - Fax:248-273-9931
Practice Address - Street 1:264 W MAPLE
Practice Address - Street 2:#200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-273-9930
Practice Address - Fax:248-273-9931
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003756363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant