Provider Demographics
NPI:1679585426
Name:SOLWAY, VICKI LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:SOLWAY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5793 W MAPLE RD
Mailing Address - Street 2:#153
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4478
Mailing Address - Country:US
Mailing Address - Phone:248-539-7726
Mailing Address - Fax:248-539-7823
Practice Address - Street 1:5793 W MAPLE RD
Practice Address - Street 2:#153
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4478
Practice Address - Country:US
Practice Address - Phone:248-539-7726
Practice Address - Fax:248-539-7823
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-03-26
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Provider Licenses
StateLicense IDTaxonomies
MI4301048796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4254762Medicaid
B48604Medicare UPIN
MIZS4301048796Medicare ID - Type Unspecified