Provider Demographics
NPI:1295901288
Name:JOLANTA SOBOTKA-CZARNECKI MD PLLC
Entity type:Organization
Organization Name:JOLANTA SOBOTKA-CZARNECKI MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOPKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-230-1790
Mailing Address - Street 1:G-5085 WEST BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2922
Mailing Address - Country:US
Mailing Address - Phone:810-230-2400
Mailing Address - Fax:810-230-1616
Practice Address - Street 1:G-5085 WEST BRISTOL RD.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2922
Practice Address - Country:US
Practice Address - Phone:810-230-2400
Practice Address - Fax:810-230-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS060311207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102503161OtherBLUE CROSS BLUE SHIELD
MI5366501OtherAETNA
MIC4922OtherMCARE
MIP60832OtherBLUE CARE NETWORK
MI0989021OtherHEALTH PLUS
MIG51998OtherUPIN
MI3360475Medicaid
MI1102503161OtherBLUE CROSS BLUE SHIELD
MIG51998OtherUPIN