Healthcare Provider Details

I. General information

NPI: 1487097820
Provider Name (Legal Business Name): ERICH OKONOWSKI MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 PAGE AVE
MICHIGAN CENTER MI
49254-1072
US

IV. Provider business mailing address

652 9TH ST
MICHIGAN CENTER MI
49254-1359
US

V. Phone/Fax

Practice location:
  • Phone: 517-244-6050
  • Fax:
Mailing address:
  • Phone: 517-990-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: