MEDICARE: DR. STEFAN GLOWACKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	SG040818	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2005071942	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093853814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN GLOWACKI M.D.

Provider Business Mailing Address
First Line	:	42370 VAN DYKE AVE
Second Line	:	SUITE 107
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3487
Country	:	US
Telephone Number	:	586-991-0051
Fax Number	:	586-991-0064

Provider Business Practice Location Address
First Line	:	42370 VAN DYKE AVE
Second Line	:	SUITE 107
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3487
Country	:	US
Telephone Number	:	586-991-0051
Fax Number	:	586-991-0064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/07/2013

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