Basic Information
| Provider Information | |||||||||
| NPI: | 1902247406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDLAWSK | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | TODD | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | REDLAWSK | ||||||||
| OtherFirstName: | JOEL | ||||||||
| OtherMiddleName: | TODD | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CPSS | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 304 S. NIAGRA ST. | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486021570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897996542 | ||||||||
| FaxNumber: | 9897996681 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 S NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486021570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897996542 | ||||||||
| FaxNumber: | 9897996681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2013 | ||||||||
| LastUpdateDate: | 11/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | Y |
No ID Information.