Basic Information
| Provider Information | |||||||||
| NPI: | 1518321132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIEKAREK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | KARL | ||||||||
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| Credential: | NPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73 | ||||||||
| Address2: | |||||||||
| City: | TECUMSEH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492860073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179204100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 SPRINGPORT RD | ||||||||
| Address2: | HENRY FORD ALLEGIANCE WOUND CARE CENTER | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492021432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177966430 | ||||||||
| FaxNumber: | 5177846984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2016 | ||||||||
| LastUpdateDate: | 04/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 4704193492 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | 4704193492 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.