Provider Demographics
NPI:1700061884
Name:MARK W. SAWKA, MDPC
Entity Type:Organization
Organization Name:MARK W. SAWKA, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:SAWKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-675-1280
Mailing Address - Street 1:25000 HALL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5112
Mailing Address - Country:US
Mailing Address - Phone:734-675-1280
Mailing Address - Fax:734-675-1678
Practice Address - Street 1:25000 HALL RD STE 1
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-5112
Practice Address - Country:US
Practice Address - Phone:734-675-1280
Practice Address - Fax:734-675-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS054908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0108281382OtherBLUE CROSS BLUE SHIELD
MIMS054908OtherST. LIC#
MI0H23901OtherBCBSM LEGACY
MI2391865003OtherCIGNA
MI4554977OtherAETNA
MIP120121OtherCARE CHOICES
MI080066594OtherMEDICARE RAILROAD
MI0828138OtherBCN
MIC7583OtherM-CARE
MIC7583OtherM-CARE
MIC7583OtherM-CARE
MIF07916Medicare UPIN
MIP120121OtherCARE CHOICES