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General NPI Number Information
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NPI Number | 1376526392
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Entity Type | Individual
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Provider Name | MICHELLE GRACE PUZDRAKIEWICZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1700 WOODLAWN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2028
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Country | US
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Telephone | 731-287-4500
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Fax | 731-287-4804
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Provider Business Mailing Address
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Address Line | 1804 HIGHWAY 45 BYP STE 604
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City | JACKSON
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State | TN
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Zip | 38305-4403
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Country | US
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Telephone | 731-660-7971
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Fax | 731-660-8739
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 308800
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 42447
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License Number State | TN
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