Provider Demographics
NPI:1508840315
Name:UZIEBLO, MACIEJ R (MD)
Entity Type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:R
Last Name:UZIEBLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:525 EAST BIG BEAVER RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-688-9860
Mailing Address - Fax:248-688-9861
Practice Address - Street 1:525 EAST BIG BEAVER RD
Practice Address - Street 2:SUITE 125
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-688-9860
Practice Address - Fax:248-688-9861
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010656542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104647142Medicaid
MIN97330003Medicare PIN
H64234Medicare UPIN