Provider Demographics
NPI:1952578080
Name:CHARLES FRANCKOWIAK D.O., P.C.
Entity Type:Organization
Organization Name:CHARLES FRANCKOWIAK D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FRANCKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-667-3501
Mailing Address - Street 1:1257 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1348
Mailing Address - Country:US
Mailing Address - Phone:810-667-3501
Mailing Address - Fax:810-667-1551
Practice Address - Street 1:1257 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1348
Practice Address - Country:US
Practice Address - Phone:810-667-3501
Practice Address - Fax:810-667-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006913208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0854410194OtherBLUE CROSS
MS0854410194OtherBLUE CARE NETWORK
MI112712831Medicaid
MI0154423035OtherHEALTHPLUS OF MICHIGAN
MIE25602Medicare UPIN
MI112712831Medicaid