Provider Demographics
NPI:1841232345
Name:JANIS M. RYGWELSKI MD, PLLC
Entity Type:Organization
Organization Name:JANIS M. RYGWELSKI MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RYGWELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-881-7750
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-0675
Mailing Address - Country:US
Mailing Address - Phone:517-881-7750
Mailing Address - Fax:517-668-0755
Practice Address - Street 1:124 E WASHINGTON ST
Practice Address - Street 2:SUITE G
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8826
Practice Address - Country:US
Practice Address - Phone:517-881-7750
Practice Address - Fax:517-668-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION85420Medicare ID - Type UnspecifiedGROUP NUMBER