Provider Demographics
NPI:1609873496
Name:SAWKA, MARK W (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:SAWKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25000 HALL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5112
Mailing Address - Country:US
Mailing Address - Phone:734-675-1280
Mailing Address - Fax:734-675-1678
Practice Address - Street 1:25000 HALL RD
Practice Address - Street 2:STE 1
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-5112
Practice Address - Country:US
Practice Address - Phone:734-675-1280
Practice Address - Fax:734-675-1678
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMS054908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H23901OtherBC LEGACY NUMBER
C7583OtherM-CARE
4554977OtherAETNA
38-3246455OtherTAX ID#
MS054908OtherST. LIC#
P120121OtherCARE CHOICES
0828138OtherMEDICARE
MI0828138OtherBCN
F07916OtherUPIN
0108281382OtherBCBS
080066594OtherRAILROAD
2391865003OtherCIGNA
0108281382OtherBCBS