Healthcare Provider Details

I. General information

NPI: 1164817573
Provider Name (Legal Business Name): ANDREW J. WOLSZCZAK, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 OVERSEAS HWY SUITE 200
MARATHON FL
33050-3200
US

IV. Provider business mailing address

8151 OVERSEAS HWY SUITE 200
MARATHON FL
33050-3200
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-6526
  • Fax: 305-743-4070
Mailing address:
  • Phone: 305-743-6526
  • Fax: 305-743-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW JAMES WOLSZCZAK
Title or Position: OWNER
Credential: M.D.
Phone: 305-743-6526