Provider Demographics
NPI:1093853814
Name:GLOWACKI, STEFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:GLOWACKI
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 1:42370 VAN DYKE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3487
Mailing Address - Country:US
Mailing Address - Phone:586-991-0051
Mailing Address - Fax:586-991-0064
Practice Address - Street 1:42370 VAN DYKE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3487
Practice Address - Country:US
Practice Address - Phone:586-991-0051
Practice Address - Fax:586-991-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG040818207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2005071942OtherBCBSM
MI1420485 10Medicaid
MI05071942Medicare ID - Type Unspecified
MIMI2994001Medicare PIN
MI1420485 10Medicaid