Provider Demographics
NPI:1922014091
Name:CICHOWLAS, MICHAEL JAMES (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:CICHOWLAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13951 PLUMBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1727
Mailing Address - Country:US
Mailing Address - Phone:586-274-2400
Mailing Address - Fax:586-274-2426
Practice Address - Street 1:13951 PLUMBROOK RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1727
Practice Address - Country:US
Practice Address - Phone:586-274-2400
Practice Address - Fax:586-274-2426
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMC012049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5284167OtherAETNA
MI700E031600OtherBCBSM GROUP PIN
MI5284167OtherAETNA
MI700E031600OtherBCBSM GROUP PIN
MI5284167OtherAETNA