Healthcare Provider Details

I. General information

NPI: 1033111026
Provider Name (Legal Business Name): MARC A TRZECIAK D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E ORANGEBURG AVE SUITE 201
MODESTO CA
95350-5512
US

IV. Provider business mailing address

609 E ORANGEBURG AVE SUITE 201
MODESTO CA
95350-5512
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-3224
  • Fax: 209-572-4528
Mailing address:
  • Phone: 209-572-3224
  • Fax: 209-572-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A12596
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number5505
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number20A12596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: