Healthcare Provider Details

I. General information

NPI: 1255860425
Provider Name (Legal Business Name): MAGDA STAWIKOWSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3000
  • Fax:
Mailing address:
  • Phone: 248-849-3000
  • Fax: 248-849-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301507688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: