Healthcare Provider Details

I. General information

NPI: 1083855316
Provider Name (Legal Business Name): WOJCIECH ZOLCIK, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S GILLETTE AVE SUITE 200
GILLETTE WY
82716-3740
US

IV. Provider business mailing address

113 S GILLETTE AVE SUITE 200
GILLETTE WY
82716-3740
US

V. Phone/Fax

Practice location:
  • Phone: 402-202-7761
  • Fax: 307-460-7417
Mailing address:
  • Phone: 402-202-7761
  • Fax: 307-460-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6219A
License Number StateWY

VIII. Authorized Official

Name: MRS. KRISMICHELLE ZOLCIK
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-202-7761