Healthcare Provider Details

I. General information

NPI: 1962452904
Provider Name (Legal Business Name): JONATHAN EDWARD PASKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MACOMB ST SUITE# 324
MONROE MI
48162-2900
US

IV. Provider business mailing address

730 N MACOMB ST SUITE# 324
MONROE MI
48162-2900
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-2440
  • Fax: 734-457-3622
Mailing address:
  • Phone: 734-242-2440
  • Fax: 734-457-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301068355
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301068355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: