MEDICARE: DOWNRIVER INTERNAL MEDICINE PC

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	207R00000X	Internal Medicine Physician	5101012714	MI

General Provider Information

NPI Number	:	1760480859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNRIVER INTERNAL MEDICINE PC

Provider Business Mailing Address
First Line	:	14600 KING RD
Second Line	:	A2
City	:	RIVERVIEW
State	:	MI
Zip	:	48192-7952
Country	:	US
Telephone Number	:	734-479-1944
Fax Number	:	313-561-0277

Provider Business Practice Location Address
First Line	:	14600 KING RD
Second Line	:	A2
City	:	RIVERVIEW
State	:	MI
Zip	:	48192-7952
Country	:	US
Telephone Number	:	734-479-1944
Fax Number	:	313-561-0277

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. HOLLE JANESKI
Credential	:	DO
Telephone Number	:	734-479-1944

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/22/2020

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