=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730203936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURENCE E STAWICK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 04/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26850 PROVIDENCE PKWY SUITE 350
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48374-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-662-4110
-----------------------------------------------------
Fax | 248-662-4120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26850 PROVIDENCE PKWY SUITE 350
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48374-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-662-4110
-----------------------------------------------------
Fax | 248-662-4120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. PAULA P STAWICK
-----------------------------------------------------
Credential | MS RD
-----------------------------------------------------
Telephone | 248-662-4110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | LS035226
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------