Provider Demographics
NPI:1962579680
Name:PULMONARY & CRITICAL CARE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:PULMONARY & CRITICAL CARE SPECIALISTS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CPC, CCP-P
Authorized Official - Phone:248-449-4864
Mailing Address - Street 1:39650 ORCHARD HILL PL
Mailing Address - Street 2:STE. 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5391
Mailing Address - Country:US
Mailing Address - Phone:248-449-7010
Mailing Address - Fax:248-449-7015
Practice Address - Street 1:39650 ORCHARD HILL PL
Practice Address - Street 2:STE. 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5391
Practice Address - Country:US
Practice Address - Phone:248-449-7010
Practice Address - Fax:248-449-7015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMONARY & CRITICAL CARE SPECIALISTS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI290F316830OtherBLUE SHIELD GROUP PIN
MI0N15080Medicare PIN