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General NPI Number Information
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NPI Number | 1194168005
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Entity Type | Individual
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Provider Name | MICHAEL MAKSIMOWSKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 4646 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-576-1000
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Fax | 313-966-1195
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Provider Business Mailing Address
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Address Line | 4646 JOHN R ST RM B2340
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City | DETROIT
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State | MI
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Zip | 48201-1916
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Country | US
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Telephone | 313-576-1000
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Fax | 313-966-1195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 4301114125
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301114125
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License Number State | MI
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