Healthcare Provider Details

I. General information

NPI: 1619387529
Provider Name (Legal Business Name): DAN LINOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 26 MILE RD
WASHINGTON MI
48094-2964
US

IV. Provider business mailing address

54465 STILLWATER DR
MACOMB MI
48042-6104
US

V. Phone/Fax

Practice location:
  • Phone: 586-677-8033
  • Fax:
Mailing address:
  • Phone: 586-786-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302030410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: