Healthcare Provider Details

I. General information

NPI: 1548243017
Provider Name (Legal Business Name): MAREK ROZYNEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 01/06/2022
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
ST JOSEPH MI
49085
US

IV. Provider business mailing address

PO BOX 235019
MONTGOMERY AL
36123-5019
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-0118
  • Fax:
Mailing address:
  • Phone: 334-279-1450
  • Fax: 334-279-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2375871
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.120536
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301085311
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: