Basic Information
| Provider Information | |||||||||
| NPI: | 1396720561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOWIRKA | ||||||||
| FirstName: | OREST | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | DO, CMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133982800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6150 CADIEUX RD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482242006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133982800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2005 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 5101012355 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 5101012355 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 020190 | 01 | MI | MIDWEST HEALTH PLAN | OTHER | 7611384 | 01 | MI | AETNA | OTHER | 1155004034 | 01 | MI | BCBS OF MICHIGAN | OTHER | 4442593 | 05 | MI | MEDICAID |