MEDICARE: DR. MACIEJ SOLAREWICZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301070588	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0F71000	OTHER	MI	BLUE CROSS BLUE SHIELD OF MICHIGAN

General Provider Information

NPI Number	:	1093792574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MACIEJ SOLAREWICZ MD

Provider Business Mailing Address
First Line	:	3438 BROOKHOLLOW DR NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9231
Country	:	US
Telephone Number	:	616-204-4364
Fax Number	:

Provider Business Practice Location Address
First Line	:	2549 MOMENTUM PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5325
Country	:	US
Telephone Number	:	269-216-9852
Fax Number	:	269-605-0018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	03/01/2021

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