Healthcare Provider Details

I. General information

NPI: 1518321132
Provider Name (Legal Business Name): DANIEL KARL PIEKAREK NPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SPRINGPORT RD HENRY FORD ALLEGIANCE WOUND CARE CENTER
JACKSON MI
49202-1432
US

IV. Provider business mailing address

PO BOX 73
TECUMSEH MI
49286-0073
US

V. Phone/Fax

Practice location:
  • Phone: 517-796-6430
  • Fax: 517-784-6984
Mailing address:
  • Phone: 517-920-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704193492
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704193492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: