Provider Demographics
NPI:1356398820
Name:RYGWELSKI, JANIS MARIE (MD)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:MARIE
Last Name:RYGWELSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E WASHINGTON ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8826
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN85420001Medicare ID - Type Unspecified
MIE85081Medicare UPIN