Healthcare Provider Details

I. General information

NPI: 1477283232
Provider Name (Legal Business Name): JONATHAN MACIEJEWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MACOMB ST STE 200
MONROE MI
48162-2904
US

IV. Provider business mailing address

730 N MACOMB ST STE 200
MONROE MI
48162-2904
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1760
  • Fax: 734-240-1780
Mailing address:
  • Phone: 734-240-1760
  • Fax: 734-240-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101029338
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34.017339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: