Provider Demographics
NPI:1700194248
Name:JOHN T. CEROVSKI, M.D., PC
Entity Type:Organization
Organization Name:JOHN T. CEROVSKI, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CEROVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-345-8626
Mailing Address - Street 1:820 JOHN ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2870
Mailing Address - Country:US
Mailing Address - Phone:269-345-8626
Mailing Address - Fax:269-345-3032
Practice Address - Street 1:820 JOHN ST
Practice Address - Street 2:STE. 103
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2870
Practice Address - Country:US
Practice Address - Phone:269-345-8626
Practice Address - Fax:269-345-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43 01 034602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0397637Medicare PIN
MIB44095Medicare UPIN