Provider Demographics
NPI:1396720561
Name:SOWIRKA, OREST JOHN (DO, CMD)
Entity type:Individual
Prefix:
First Name:OREST
Middle Name:JOHN
Last Name:SOWIRKA
Suffix:
Gender:M
Credentials:DO, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HALL ST SW STE 263
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4988
Mailing Address - Country:US
Mailing Address - Phone:616-719-0919
Mailing Address - Fax:616-719-0933
Practice Address - Street 1:401 HALL ST SW STE 263
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4988
Practice Address - Country:US
Practice Address - Phone:616-719-0919
Practice Address - Fax:616-719-0933
Is Sole Proprietor?:No
Enumeration Date:2005-12-10
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012355207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1155004034OtherBCBS OF MICHIGAN
MI4442593Medicaid
MI7611384OtherAETNA
MI020190OtherMIDWEST HEALTH PLAN
MIH09706Medicare UPIN
MI020190OtherMIDWEST HEALTH PLAN