Provider Demographics
NPI:1932224961
Name:JAMSEK ROLNICK, MARIETA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIETA
Middle Name:
Last Name:JAMSEK ROLNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIETA
Other - Middle Name:
Other - Last Name:JAMSEK ROLNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:251 E MERRILL ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6121
Mailing Address - Country:US
Mailing Address - Phone:248-646-3610
Mailing Address - Fax:248-646-0728
Practice Address - Street 1:251 E MERRILL ST
Practice Address - Street 2:SUITE 230
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6121
Practice Address - Country:US
Practice Address - Phone:248-646-3610
Practice Address - Fax:248-646-0728
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMJ43010363472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2606356041OtherBLUE CROSS AND BLUE SHIEL
MIMI2104309Medicaid
MI2606356041OtherBLUE CROSS AND BLUE SHIEL
MI0630143Medicare ID - Type Unspecified