Individual
DR. JACEK R BRUDZEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4201 SAINT ANTOINE ST, SUITE 3R, DETROIT, MI 48201-2153
(313) 745-3000
Mailing address
515 RIDGEMONT AVE, DEARBORN, MI 48124-1220
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301046535
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101987795
—
MI
05
—
104476377
—
MI
01
—
JB046535
BC/BS OF MICHIGAN
MI
Enumeration date
05/26/2006
Last updated
04/10/2019
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