Basic Information
| Provider Information | |||||||||
| NPI: | 1376895151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIESZCZAK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CPSS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31342 SETTLERS WAY DR | ||||||||
| Address2: | |||||||||
| City: | FLAT ROCK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481343333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347757335 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14799 DIX TOLEDO RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343248326 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MI | Y | Other Service Providers | Specialist |
No ID Information.