Provider Demographics
NPI:1619199171
Name:TRZECIAK, JANN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JANN
Middle Name:E
Last Name:TRZECIAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-0685
Mailing Address - Country:US
Mailing Address - Phone:866-898-7139
Mailing Address - Fax:616-975-9827
Practice Address - Street 1:1915 N PERRT STREET
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340
Practice Address - Country:US
Practice Address - Phone:248-276-3999
Practice Address - Fax:248-276-3998
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011299207QH0002X
MI5101012099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1619199171Medicaid
MIJT012099OtherBCBS
MI1619199171Medicaid
MIMI1504Medicare PIN
MI0M92460033Medicare PIN
MIJT012099OtherBCBS
MIMI1503Medicare PIN
MIMI1504014Medicare UPIN