Provider Demographics
NPI:1972827244
Name:STEFAN GLOWACKI M.D.,P.C.
Entity Type:Organization
Organization Name:STEFAN GLOWACKI M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-991-0051
Mailing Address - Street 1:42370 VAN DYKE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3487
Mailing Address - Country:US
Mailing Address - Phone:586-991-0051
Mailing Address - Fax:586-991-0064
Practice Address - Street 1:42370 VAN DYKE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3487
Practice Address - Country:US
Practice Address - Phone:586-991-0051
Practice Address - Fax:586-991-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG040818207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2005071942OtherBCBSM
2000E03267OtherBCBSM
MI142048510Medicaid
MI142048510Medicaid
2000E03267OtherBCBSM
MI2994Medicare PIN