Provider Demographics
NPI:1205885787
Name:GETZINGER, JEF (MD)
Entity type:Individual
Prefix:
First Name:JEF
Middle Name:
Last Name:GETZINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13350 24 MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-1826
Mailing Address - Country:US
Mailing Address - Phone:586-566-7100
Mailing Address - Fax:586-566-8088
Practice Address - Street 1:15055 22 MILE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4401
Practice Address - Country:US
Practice Address - Phone:586-566-7100
Practice Address - Fax:586-566-8088
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4373834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4373834Medicaid
MI700E031610OtherBCBS GROUP NUMBER
MIG16663Medicare UPIN
MI4373834Medicaid
MIMI3971Medicare PIN