Provider Demographics
NPI:1750373478
Name:SAWKA, JAROSLAW (DO)
Entity type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:
Last Name:SAWKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27774 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2352
Mailing Address - Country:US
Mailing Address - Phone:248-356-5555
Mailing Address - Fax:248-356-5544
Practice Address - Street 1:3040 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1662
Practice Address - Country:US
Practice Address - Phone:313-368-0705
Practice Address - Fax:313-368-0727
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4540191-11Medicaid
M84700029Medicare UPIN
MI4540191-11Medicaid