=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811022932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OREST J SOWIRKA DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 09/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 WATKINS LAKE RD
-----------------------------------------------------
City | WATERFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48328-1439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-674-2241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 237
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48311-0237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-945-9003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OREST J SOWIRKA
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 586-945-9003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OS012355
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------