Provider Demographics
NPI:1801536081
Name:MACIEJEWSKI, JOSHUA MADISON
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MADISON
Last Name:MACIEJEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12640 STONERIDGE LN APT 204
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48179-9555
Mailing Address - Country:US
Mailing Address - Phone:813-579-8061
Mailing Address - Fax:
Practice Address - Street 1:12640 STONERIDGE LN APT 204
Practice Address - Street 2:
Practice Address - City:SOUTH ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48179-9555
Practice Address - Country:US
Practice Address - Phone:813-579-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program