Provider Demographics
NPI:1023010063
Name:HOLOWINSKI, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:HOLOWINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3247
Mailing Address - Country:US
Mailing Address - Phone:586-443-4063
Mailing Address - Fax:586-443-4064
Practice Address - Street 1:24100 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3247
Practice Address - Country:US
Practice Address - Phone:586-443-4063
Practice Address - Fax:586-443-4064
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBSM GROUP NUMBER
MI4133079Medicaid
MI700E012740OtherBCBSM GROUP NUMBER
MI0N40170Medicare PIN
MIH08307Medicare UPIN
MI4133079Medicaid