Provider Demographics
NPI:1801956040
Name:MARKIEWICZ, CAROL JEAN (DO)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:MARKIEWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 HARVEY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4274
Mailing Address - Country:US
Mailing Address - Phone:231-777-2748
Mailing Address - Fax:231-777-1529
Practice Address - Street 1:684 HARVEY ST STE 102
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4274
Practice Address - Country:US
Practice Address - Phone:231-777-2748
Practice Address - Fax:231-777-1529
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006848207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1332293Medicaid
MIN91530002Medicare ID - Type Unspecified
MIE25618Medicare UPIN