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General NPI Number Information
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NPI Number | 1124018296
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Entity Type | Individual
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Provider Name | JANE E KRASNICK MD
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Gender | Female
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 37130 HOOVER RD SUITE A
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-268-9222
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Fax | 586-268-9226
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Provider Business Mailing Address
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Address Line | 31730 HOOVER RD SUITE A
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City | WARREN
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State | MI
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Zip | 48093-1700
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Country | US
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Telephone | 586-268-9222
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Fax | 568-268-9226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 4301067218
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License Number State | MI
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