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General NPI Number Information
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NPI Number | 1700194248
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Entity Type | Organization
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Legal Business Name | JOHN T. CEROVSKI, M.D., PC
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 820 JOHN ST STE. 103
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City | KALAMAZOO
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State | MI
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Zip | 49001-2870
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Country | US
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Telephone | 269-345-8626
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Fax | 269-345-3032
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Provider Business Mailing Address
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Address Line | 820 JOHN ST STE. 103
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City | KALAMAZOO
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State | MI
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Zip | 49001-2870
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Country | US
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Telephone | 269-345-8626
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Fax | 269-345-3032
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN THOMAS CEROVSKI
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Credential | MD
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Telephone | 269-345-8626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 43 01 034602
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License Number State | MI
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