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NPI Code Detail

MEDICARE: MR. CODY MICHAEL LAWNICHAK PA-C

MEDICARE: MR. CODY MICHAEL LAWNICHAK PA-C
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
1363A00000XPhysician Assistant5601007061MI

General Provider Information

NPI Number : 1992112346
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CODY MICHAEL LAWNICHAK PA-C
Provider Business Mailing Address
First Line : PO BOX 427
Second Line :
City : HILLMAN
State : MI
Zip : 49746-0427
Country : US
Telephone Number : 989-354-2197
Fax Number : 989-356-6524
Provider Business Practice Location Address
First Line : 205 S BRADLEY HWY
Second Line :
City : ROGERS CITY
State : MI
Zip : 49779-2137
Country : US
Telephone Number : 989-734-2052
Fax Number : 989-734-7390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2014
Last Update Date : 01/12/2015

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