Healthcare Provider Details

I. General information

NPI: 1396720561
Provider Name (Legal Business Name): OREST JOHN SOWIRKA DO, CMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2005
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 LORMAN DR
STERLING HEIGHTS MI
48312-4964
US

IV. Provider business mailing address

11120 LORMAN DR
STERLING HEIGHTS MI
48312-4964
US

V. Phone/Fax

Practice location:
  • Phone: 586-945-9003
  • Fax:
Mailing address:
  • Phone: 586-945-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number5101012355
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number5101012355
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101012355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: