Healthcare Provider Details

I. General information

NPI: 1750254488
Provider Name (Legal Business Name): MARIUSZ SAPIJASZKO MD, FRCP, MMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950-10665 JASPER AVE NW
EDMONTON AB
T5J3S9
CA

IV. Provider business mailing address

11969 JASPER AVE NW 3102
EDMONTON AB
T5K0P1
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA72162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA72162
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA72162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: