Healthcare Provider Details

I. General information

NPI: 1386870251
Provider Name (Legal Business Name): BARTOSZ J GRZYWACZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW HOSPITAL AND CLINICS 600 HIGHLAND AVE, H4/831
MADISON WI
53792-0001
US

IV. Provider business mailing address

UW HOSPITAL AND CLINICS 600 HIGHLAND AVE, H4/831
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-0572
  • Fax: 608-890-7127
Mailing address:
  • Phone:
  • Fax: 608-890-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number107470
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number107470
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: