Provider Demographics
NPI:1104083880
Name:WIERCIGROCH, MICHAL WOJCIECH (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:WOJCIECH
Last Name:WIERCIGROCH
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 412031
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2031
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:2835 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1448
Practice Address - Country:US
Practice Address - Phone:248-377-8220
Practice Address - Fax:248-341-1219
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501013770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750026Medicare PIN
MIMI6211027Medicare PIN