Healthcare Provider Details

I. General information

NPI: 1811149115
Provider Name (Legal Business Name): JENNIFER MICHELLE PIWOWARSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 MACKINAW TRL
CADILLAC MI
49601-8111
US

IV. Provider business mailing address

3782 MOMENTUM PL
CHICAGO IL
60689-5337
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-6200
  • Fax: 231-876-6299
Mailing address:
  • Phone: 231-935-6080
  • Fax: 231-935-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301090555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: