Provider Demographics
NPI:1992112346
Name:LAWNICHAK, CODY MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:MICHAEL
Last Name:LAWNICHAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:HILLMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49746-0427
Mailing Address - Country:US
Mailing Address - Phone:989-354-2197
Mailing Address - Fax:989-356-6524
Practice Address - Street 1:205 S BRADLEY HWY
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-2137
Practice Address - Country:US
Practice Address - Phone:989-734-2052
Practice Address - Fax:989-734-7390
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN