Healthcare Provider Details

I. General information

NPI: 1811988058
Provider Name (Legal Business Name): RANDY J JANCZYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD STE 204
ROYAL OAK MI
48073
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY STE C
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-9090
  • Fax: 248-551-9080
Mailing address:
  • Phone: 248-851-1430
  • Fax: 248-851-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301067765
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: