Individual
THADDEUS F JUSZCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 S HEALTH PKWY, THREE RIVERS, MI 49093-8352
(269) 278-1145
(269) 273-9611
Mailing address
701 S HEALTH PKWY, MEDICAL STAFF OFFICE, THREE RIVERS, MI 49093-8352
(269) 273-9789
(269) 273-9611
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704106613
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G51062
BCBS
MI
05
—
4893487-10
—
MI
01
—
700G560080
BCBS GROUP-THREE RIVERS HEALTH
MI
Enumeration date
05/24/2006
Last updated
10/30/2008
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