Provider Demographics
NPI:1710953914
Name:STAWICK, LAURENCE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:EDWARD
Last Name:STAWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-662-4110
Mailing Address - Fax:248-662-4120
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-662-4110
Practice Address - Fax:248-662-4120
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MILS035226207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB47505OtherALLIANCE HEALTH AND LIFE
MIB47505OtherGARDEN CITY HOSPITAL PROF
MIDN8656OtherMEDICARE RAILROAD
MI382814063OtherUNITED HEALTHCARE
MI1000F34457OtherBCBSM
MI103533OtherPRIORITY HEALTH
MI142605XXOtherPREFERRED CARE ADMIN SERV
MI1922048Medicaid
MI0P44190OtherMEDICARE ADVANTAGE BLUE
MI1000F34457OtherBCN
MI382814063OtherCOFINITY
MIB47505OtherHAP PREFERRED PPO
MI382814063OtherAETNA
MIB47505OtherHEALTH ALLIANCE PLAN
MI382814063OtherUNITED HEALTHCARE
MI382814063OtherAETNA