1730203936 NPI number — LAURENCE E STAWICK MD PC

Table of content: (NPI 1730203936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730203936 NPI number — LAURENCE E STAWICK MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURENCE E STAWICK MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1730203936
Entity Type Code:
Organization
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:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STAWICK
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
248-662-4110

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: 0P44190 . This is a "MEDICARE ADVANTAGE BLUE" 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: 1922048 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: B47505 . This is a "HEALTH ALLIANCE PLAN" 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: 1000F34457 . This is a "BCN" 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: DN8656 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B47505 . This is a "ALLIANCE HEALTH AND LIFE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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