Provider Demographics
NPI:1760480859
Name:DOWNRIVER INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:DOWNRIVER INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-479-1944
Mailing Address - Street 1:14600 KING RD
Mailing Address - Street 2:A2
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48192-7952
Mailing Address - Country:US
Mailing Address - Phone:734-479-1944
Mailing Address - Fax:313-561-0277
Practice Address - Street 1:14600 KING RD
Practice Address - Street 2:A2
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48192-7952
Practice Address - Country:US
Practice Address - Phone:734-479-1944
Practice Address - Fax:313-561-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty