Provider Demographics
NPI:1801470059
Name:PTASNIK, EMILY ANN (DO)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANN
Last Name:PTASNIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2117
Mailing Address - Country:US
Mailing Address - Phone:231-420-2140
Mailing Address - Fax:
Practice Address - Street 1:761 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2117
Practice Address - Country:US
Practice Address - Phone:231-420-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014993207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology