Provider Demographics
NPI:1730203936
Name:LAURENCE E STAWICK MD PC
Entity type:Organization
Organization Name:LAURENCE E STAWICK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:P
Authorized Official - Last Name:STAWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD
Authorized Official - Phone:248-662-4110
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-662-4110
Mailing Address - Fax:248-662-4120
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-662-4110
Practice Address - Fax:248-662-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS035226207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P44190OtherMEDICARE ADVANTAGE BLUE
MIB47505OtherHAP PREFERRED PPO
MI1922048Medicaid
MIB47505OtherHEALTH ALLIANCE PLAN
MI1000F34457OtherBCBSM
MI1000F34457OtherBCN
MI103533OtherPRIORITY HEALTH
MI142605XXOtherPREFERRED CARE ADMIN SERV
MIDN8656OtherMEDICARE RAILROAD
MIB47505OtherALLIANCE HEALTH AND LIFE
MI1922048Medicaid
MI1000F34457OtherBCBSM
MIB47505OtherGARDEN CITY HOSPITAL PROF
MI1922048Medicaid
MI1006382771OtherBLUE CARE NETWORK
MIB47505OtherALLIANCE HEALTH AND LIFE