Provider Demographics
NPI:1962408393
Name:VLACH, JAN J (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:J
Last Name:VLACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 N US 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4533
Mailing Address - Country:US
Mailing Address - Phone:231-929-1234
Mailing Address - Fax:231-935-0984
Practice Address - Street 1:3074 N US 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4533
Practice Address - Country:US
Practice Address - Phone:231-929-1234
Practice Address - Fax:231-935-0984
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962408393OtherJAN VLACH MD
MI38353068654OtherCOMMUNITY CHOICE
MI4391556Medicaid
MI1962408393OtherINDIVIDUAL NPI NUMBER
MI080189369OtherRAILROAD MEDICARE
MI132959OtherCARE CHOICES
MI1851344964OtherCORP NPI
MIA77940OtherPRIORITY HEALTH
MI1962408393Medicaid
MI700B810660OtherBLUE CARE NETWORK
MI383530686OtherPPOM
MI000000008909OtherCAP HEALTH
MI0B81066OtherBLUE CARE NETWORK
MI131726OtherUNITED HEALTH
MI349386200OtherUS POSTAL
MI4391556Medicaid
MI1962408393Medicaid