Provider Demographics
NPI:1013467794
Name:DR. MICHAEL T. OWCZARZAK, P.C.
Entity type:Organization
Organization Name:DR. MICHAEL T. OWCZARZAK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWCZARZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-3660
Mailing Address - Street 1:5142 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1042
Mailing Address - Country:US
Mailing Address - Phone:810-733-3660
Mailing Address - Fax:810-720-4777
Practice Address - Street 1:5142 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1042
Practice Address - Country:US
Practice Address - Phone:810-733-3660
Practice Address - Fax:810-720-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty