Provider Demographics
NPI:1093792574
Name:SOLAREWICZ, MACIEJ (MD)
Entity Type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:
Last Name:SOLAREWICZ
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 1:3438 BROOKHOLLOW DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9231
Mailing Address - Country:US
Mailing Address - Phone:616-204-4364
Mailing Address - Fax:
Practice Address - Street 1:2549 MOMENTUM PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60689-5325
Practice Address - Country:US
Practice Address - Phone:269-216-9852
Practice Address - Fax:269-605-0018
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070588207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4613055Medicaid
MA4812040Medicaid
MI4666101Medicaid
MI4767810Medicaid
MI0F71000OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4666101Medicaid
N91320004Medicare ID - Type Unspecified
MI0F76001Medicare PIN