Provider Demographics
NPI:1003924820
Name:KWARTOWITZ, GARY S (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:KWARTOWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5701 BOW POINTE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3198
Mailing Address - Country:US
Mailing Address - Phone:248-620-3100
Mailing Address - Fax:248-620-3019
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3198
Practice Address - Country:US
Practice Address - Phone:248-620-3100
Practice Address - Fax:248-620-3019
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIGK012039207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3477100Medicaid
MI3477100Medicaid
MIOM705700Medicare UPIN