MEDICARE: MARKIAN R IWASZKO MD

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	208800000X	Urology Physician	01089840A	IN
2	208800000X	Urology Physician	4301095939	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34OD160430	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1659380939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARKIAN R IWASZKO MD

Provider Business Mailing Address
First Line	:	1000 E PARIS AVE SE STE 230
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3680
Country	:	US
Telephone Number	:	616-949-4340
Fax Number	:	616-949-4341

Provider Business Practice Location Address
First Line	:	1000 E PARIS AVE SE STE 230
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3680
Country	:	US
Telephone Number	:	616-949-4340
Fax Number	:	616-949-4341

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	12/16/2025

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Directions to “ MARKIAN R IWASZKO MD” Practice Location

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