Provider Demographics
NPI:1962540419
Name:JANSEN, JOHN ALEX JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEX
Last Name:JANSEN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING/PAYOR CONTACTING
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-805-0487
Mailing Address - Fax:866-250-6385
Practice Address - Street 1:7300 N CANTON CENTER RD
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1579
Practice Address - Country:US
Practice Address - Phone:734-454-8002
Practice Address - Fax:866-250-6385
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2010-05-21
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Provider Licenses
StateLicense IDTaxonomies
MI4301045424207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962540419Medicaid
MIP40540104Medicare PIN
MIQ26294438Medicare PIN
MIN87430087Medicare PIN