Healthcare Provider Details

I. General information

NPI: 1194959643
Provider Name (Legal Business Name): JOSEPH MICHAEL WIERZBICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9077 S FEDERAL HWY
PORT SAINT LUCIE FL
34952-3405
US

IV. Provider business mailing address

9077 S FEDERAL HWY
PORT SAINT LUCIE FL
34952-3405
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-4770
  • Fax: 772-335-4133
Mailing address:
  • Phone: 772-335-4770
  • Fax: 772-335-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME109987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: