Provider Demographics
NPI:1649769209
Name:PRZEKLASA, MARY (BS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PRZEKLASA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 REDMAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2738
Mailing Address - Country:US
Mailing Address - Phone:734-788-6506
Mailing Address - Fax:
Practice Address - Street 1:26650 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4835
Practice Address - Country:US
Practice Address - Phone:734-788-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator