Provider Demographics
NPI:1841260536
Name:LASKOWSKI, RICHARD P (D O)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:LASKOWSKI
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 KING RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7952
Mailing Address - Country:US
Mailing Address - Phone:734-479-1522
Mailing Address - Fax:734-479-1524
Practice Address - Street 1:14600 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7952
Practice Address - Country:US
Practice Address - Phone:734-479-1522
Practice Address - Fax:734-479-1524
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006654208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1836155Medicaid
MIE26623Medicare UPIN
MI58228313061Medicare ID - Type Unspecified