Provider Demographics
NPI:1538256383
Name:JAREMBA, MICHAEL PATRICK (BC-HIS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:JAREMBA
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G-4080 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-732-6200
Mailing Address - Fax:810-732-8618
Practice Address - Street 1:G-4080 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-732-6200
Practice Address - Fax:810-732-8618
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501003042237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540B50321OtherBLUE CROSS & BLUE CARE
MI540B50138OtherBLUE CROSS AND BLUE CARE NETWORK
MI540B51444OtherBLUE CROSS AND BLUE CARE NETWORK