MEDICARE: STEPHEN JAMES WASZAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD00015444	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295842979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN JAMES WASZAK M.D.

Provider Business Mailing Address
First Line	:	3216 NE 45TH PL STE 212
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4028
Country	:	US
Telephone Number	:	206-386-3600
Fax Number	:	206-526-9159

Provider Business Practice Location Address
First Line	:	3216 NE 45TH PL STE 212
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4028
Country	:	US
Telephone Number	:	206-386-3600
Fax Number	:	206-526-9159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	11/21/2007

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