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General NPI Number Information
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NPI Number | 1588688147
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Entity Type | Individual
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Provider Name | JEANETTE K SLADICK PA
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 18101 OAKWOOD BLVD TRAUMA SERVICES
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City | DEARBORN
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State | MI
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Zip | 48124-4089
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Country | US
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Telephone | 313-982-5440
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Fax | 313-982-5445
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10112
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601005370
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License Number State | MI
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