Provider Demographics
NPI:1922072206
Name:PAWLIK, GERALDINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:L
Last Name:PAWLIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-5032
Mailing Address - Country:US
Mailing Address - Phone:313-271-8560
Mailing Address - Fax:313-271-2831
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:STE 209
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-271-8560
Practice Address - Fax:313-271-2831
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066774208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC3203OtherMCARE INDIVIDUAL PIN#
MI02-0822050-1OtherBCBSM INDIVIDUAL PIN#
MI020H263670OtherBCBSM GROUP PIN#
MI3185722Medicaid
MI3185722Medicaid
MIC3203OtherMCARE INDIVIDUAL PIN#