MEDICARE: JOHN STEPHEN DUGINSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704354352	MI

General Provider Information

NPI Number	:	1013769702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN STEPHEN DUGINSKI

Provider Business Mailing Address
First Line	:	707 W MILWAUKEE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2454 MIDDLEBELT RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-1841
Country	:	US
Telephone Number	:	414-750-6213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/04/2024

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