Provider Demographics
NPI:1164403663
Name:HAWK ASSOCIATES INC
Entity Type:Organization
Organization Name:HAWK ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JELINEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:810-648-9626
Mailing Address - Street 1:309 S ELK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1329
Mailing Address - Country:US
Mailing Address - Phone:810-648-9626
Mailing Address - Fax:810-648-9626
Practice Address - Street 1:309 S ELK ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471
Practice Address - Country:US
Practice Address - Phone:810-648-9626
Practice Address - Fax:810-648-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650G657010OtherBCBSMI
MI4676225OtherAETNA
MI3182480Medicaid
MI0M146Medicare ID - Type Unspecified
MI4676225OtherAETNA