Provider Demographics
NPI:1891881264
Name:SAWALICH, STEVEN P
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:SAWALICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-0009
Mailing Address - Country:US
Mailing Address - Phone:618-937-6419
Mailing Address - Fax:618-937-6410
Practice Address - Street 1:1000 FACTORY OUTLET BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-4179
Practice Address - Country:US
Practice Address - Phone:618-937-6419
Practice Address - Fax:618-937-6410
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL0567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist