Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 4301030349 | MI |
Y | 207ND0900X | Dermatopathologist | 4301030349 | MI |
NPI | 1679573331 |
---|---|
Provider Name | Mr. Marek A Stawiski |
First Address | Grand Rapids, MI 49503-3523 |
Second Address | Grand Rapids, MI 49503-3523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 22/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0724106641 | BCBSM (01) | MI |
4687587 | (05) | MI |
D83114 | (02) | |
P00236428 | RRB MEDICARE (01) | MI |