Individual
ELLEN AMANDA JANETZKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
60 W BIG BEAVER RD STE 100, BLOOMFIELD HILLS, MI 48304-3913
(248) 258-5100
Mailing address
60 W BIG BEAVER RD, STE 100, BLOOMFIELD HILLS, MI 48304-3913
(248) 258-5100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301066875
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0634039
BLUE CROSS BLUE SHIELD
MI
05
—
4427695
—
MI
01
—
7316280
AETNA
MI
Enumeration date
11/03/2005
Last updated
05/20/2021
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