Provider Demographics
NPI:1790760569
Name:ORZECHOWSKI, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ORZECHOWSKI
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 1:30117 SCHOENHERR RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6854
Mailing Address - Country:US
Mailing Address - Phone:586-558-7335
Mailing Address - Fax:586-558-7340
Practice Address - Street 1:11446 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6571
Practice Address - Country:US
Practice Address - Phone:586-558-7335
Practice Address - Fax:586-558-7340
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4662837Medicaid
MI0N78540014Medicare ID - Type Unspecified
MI4662837Medicaid