MEDICARE: JOEL WISZNIAK 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	207N00000X	Dermatology Physician	ME53127	FL

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

General Provider Information

NPI Number	:	1861413395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL WISZNIAK MD

Provider Business Mailing Address
First Line	:	601 N. FEDERAL HIGHWAY
Second Line	:	STE 401
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2106
Country	:	US
Telephone Number	:	954-454-1066
Fax Number	:	954-456-4025

Provider Business Practice Location Address
First Line	:	601 N. FEDERAL HIGHWAY
Second Line	:	STE 401
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2106
Country	:	US
Telephone Number	:	954-454-1066
Fax Number	:	954-456-4025

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/20/2024

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