Healthcare Provider Details

I. General information

NPI: 1366432981
Provider Name (Legal Business Name): ROBERT C CZARNECKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR STE 135
ROCHESTER MI
48307
US

IV. Provider business mailing address

1135 W UNIVERSITY DR STE 135
ROCHESTER MI
48307
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-0606
  • Fax: 248-651-5335
Mailing address:
  • Phone: 248-651-0606
  • Fax: 248-651-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number4301063421
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: