Healthcare Provider Details

I. General information

NPI: 1295912509
Provider Name (Legal Business Name): WOJCIECH ZOLCIK M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W BRUNDAGE ST
SHERIDAN WY
82801-4217
US

IV. Provider business mailing address

PO BOX 7060
GILLETTE WY
82716
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-1665
  • Fax: 307-687-7243
Mailing address:
  • Phone: 307-674-1720
  • Fax: 307-687-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WOJCIECH ZOLCIK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 307-674-1665