Healthcare Provider Details

I. General information

NPI: 1295819902
Provider Name (Legal Business Name): NORBERT P CZAJKOWSKI, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PINE GROVE AVE
PORT HURON MI
48060-3733
US

IV. Provider business mailing address

PO BOX 26010
FRASER MI
48026-6010
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-3200
  • Fax: 810-982-4480
Mailing address:
  • Phone: 586-296-7250
  • Fax: 586-296-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: NORBERT P CZAJKOWSKI
Title or Position: DIRECTOR
Credential: M.D.
Phone: 586-296-7250