Individual
MICHAEL JACEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1211 UNION AVE, STE 200, MEMPHIS, TN 38104-6638
(901) 259-5340
(901) 259-5300
Mailing address
6325 HUMPHREYS BLVD, MEMPHIS, TN 38120
(901) 522-7700
(901) 522-2600
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD22223
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3067379
—
TN
Enumeration date
12/06/2005
Last updated
02/21/2008
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