1710953914 NPI number — LAURENCE EDWARD STAWICK M.D.

Table of content: LAURENCE EDWARD STAWICK M.D. (NPI 1710953914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710953914 NPI number — LAURENCE EDWARD STAWICK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAWICK
Provider First Name:
LAURENCE
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710953914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-662-4110
Provider Business Mailing Address Fax Number:
248-662-4120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-662-4110
Provider Business Practice Location Address Fax Number:
248-662-4120
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  LS035226 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B47505 . This is a "ALLIANCE HEALTH AND LIFE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B47505 . This is a "GARDEN CITY HOSPITAL PROF" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DN8656 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382814063 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1000F34457 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103533 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 142605XX . This is a "PREFERRED CARE ADMIN SERV" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1922048 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0P44190 . This is a "MEDICARE ADVANTAGE BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1000F34457 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382814063 . This is a "COFINITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B47505 . This is a "HAP PREFERRED PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382814063 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B47505 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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