Basic Information
Provider Information
NPI: 1033557939
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAJEWSKI
FirstName: RUSSELL
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 3621 S STATE ST
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DR
Address2: 3RD FLOOR TAUBMAN CENTER RECP B
City: ANN ARBOR
State: MI
PostalCode: 481095352
CountryCode: US
TelephoneNumber: 7349365582
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2013
LastUpdateDate: 09/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X4301103518MIY Allopathic & Osteopathic PhysiciansInternal Medicine 
390200000X4301103518MIN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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