Healthcare Provider Details

I. General information

NPI: 1578586095
Provider Name (Legal Business Name): EDWARD JOSEPH WOJCIECHOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 HASKINS RD SUITE A
BOWLING GREEN OH
43402-9065
US

IV. Provider business mailing address

745 HASKINS RD SUITE B
BOWLING GREEN OH
43402-1637
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-1121
  • Fax: 419-352-1179
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 Number35.073273
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: