Healthcare Provider Details

I. General information

NPI: 1598461899
Provider Name (Legal Business Name): MARK MURAWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22600 HALL RD STE 201
CLINTON TOWNSHIP MI
48036-1173
US

IV. Provider business mailing address

40905 MAGNOLIA DR W
CLINTON TOWNSHIP MI
48038-4103
US

V. Phone/Fax

Practice location:
  • Phone: 586-496-4503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008324
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: