Healthcare Provider Details

I. General information

NPI: 1811022932
Provider Name (Legal Business Name): OREST J SOWIRKA DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WATKINS LAKE RD
WATERFORD MI
48328-1439
US

IV. Provider business mailing address

PO BOX 237
STERLING HEIGHTS MI
48311-0237
US

V. Phone/Fax

Practice location:
  • Phone: 248-674-2241
  • Fax:
Mailing address:
  • Phone: 586-945-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS012355
License Number StateMI

VIII. Authorized Official

Name: OREST J SOWIRKA
Title or Position: PRESIDENT
Credential: DO
Phone: 586-945-9003