MEDICARE: MS. JANET E. GUMENICK

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	1041C0700X	Clinical Social Worker	6801064340	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80089-6681-0	OTHER	MI	BLUE CROSS

General Provider Information

NPI Number	:	1750444022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET E. GUMENICK

Provider Business Mailing Address
First Line	:	7151 SUNCREST RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4341
Country	:	US
Telephone Number	:	248-358-1660
Fax Number	:	248-737-1877

Provider Business Practice Location Address
First Line	:	7151 SUNCREST RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4341
Country	:	US
Telephone Number	:	248-358-1660
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/13/2007

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