Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301108000 | MI |
NPI | 1013395961 |
---|---|
Provider Name | Mark Goralewski |
First Address | Livonia, MI 48154-5429 |
Second Address | Livonia, MI 48154-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 26/02/2020 |