Healthcare Provider Details

I. General information

NPI: 1447248265
Provider Name (Legal Business Name): THOMAS E WOJCIECHOWSKI SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 RIDGEWOOD DR SUITE B
BOWLING GREEN OH
43402-2690
US

IV. Provider business mailing address

745 HASKINS RD SUITE B
BOWLING GREEN OH
43402-1600
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-9071
  • Fax: 419-352-9073
Mailing address:
  • Phone: 419-353-7069
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35039901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: