Healthcare Provider Details

I. General information

NPI: 1548257249
Provider Name (Legal Business Name): STEVEN C MISZKIEWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ICE LAKE RD
IRON RIVER MI
49935-8509
US

IV. Provider business mailing address

301 EXPLORER ST
GWINN MI
49841-2813
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-5378
  • Fax: 906-265-5378
Mailing address:
  • Phone: 906-481-8586
  • Fax: 906-265-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD14419
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14419
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301512874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: