Healthcare Provider Details

I. General information

NPI: 1649544040
Provider Name (Legal Business Name): SCOTT RAYMOND SAWINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD
WARREN MI
48093-3472
US

IV. Provider business mailing address

27351 DEQUINDRE RD
MADISON HTS MI
48071-3487
US

V. Phone/Fax

Practice location:
  • Phone: 517-256-5370
  • Fax:
Mailing address:
  • Phone: 517-256-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704254460
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: