Provider Demographics
NPI:1619978384
Name:PAWLICKI, MATTHEW BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BERNARD
Last Name:PAWLICKI
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-286-8841
Mailing Address - Fax:440-286-8867
Practice Address - Street 1:100 SEVENTH AVE STE 111
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7802
Practice Address - Country:US
Practice Address - Phone:440-286-8841
Practice Address - Fax:440-286-8867
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-839943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499872Medicaid
OH83994OtherSTATE LICENSE
H90381Medicare UPIN
4139992Medicare PIN