Provider Demographics
NPI:1427752401
Name:KACZMARCZYK, JACK LOUIS JR (NP)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:LOUIS
Last Name:KACZMARCZYK
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:221 W WEBSTER AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1294
Mailing Address - Country:US
Mailing Address - Phone:231-335-1630
Mailing Address - Fax:231-259-4395
Practice Address - Street 1:221 W WEBSTER AVE STE 303
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1294
Practice Address - Country:US
Practice Address - Phone:231-335-1630
Practice Address - Fax:231-259-4395
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704310792163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse