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General NPI Number Information
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NPI Number | 1164472635
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Entity Type | Individual
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Provider Name | BARBARA ANNE WENCZAK MD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 12200 W COLONIAL DR SUITE 102
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4125
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Country | US
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Telephone | 407-877-1026
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Fax | 407-877-1028
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Provider Business Mailing Address
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Address Line | 12200 W COLONIAL DR SUITE 102
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4125
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Country | US
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Telephone | 407-877-1026
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Fax | 407-877-1028
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 69776
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License Number State | FL
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