Healthcare Provider Details

I. General information

NPI: 1427030121
Provider Name (Legal Business Name): MICHAEL J ZAWISZA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 S GARFIELD AVE
SCHUYLKILL HAVEN PA
17972-1107
US

IV. Provider business mailing address

523 S GARFIELD AVE
SCHUYLKILL HAVEN PA
17972-1107
US

V. Phone/Fax

Practice location:
  • Phone: 570-385-3826
  • Fax: 570-385-4125
Mailing address:
  • Phone: 570-385-3826
  • Fax: 570-385-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS006180L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: