Provider Demographics
NPI:1427752401
Name:KACZMARCZYK, JACK LOUIS JR (RN)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:LOUIS
Last Name:KACZMARCZYK
Suffix:JR
Gender:M
Credentials:RN
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Mailing Address - Street 1:1748 CHATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-9467
Mailing Address - Country:US
Mailing Address - Phone:616-402-7777
Mailing Address - Fax:
Practice Address - Street 1:40600 ANN ARBOR RD E STE 201
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4675
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-10-17
Deactivation Date:
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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