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General NPI Number Information
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NPI Number | 1629291992
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Entity Type | Organization
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Legal Business Name | MICHAEL WADZINSKI, PC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 2800 PIERCE ST SUITE 404
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City | SIOUX CITY
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State | IA
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Zip | 51104-3759
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Country | US
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Telephone | 712-226-3937
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Fax | 712-224-3973
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Provider Business Mailing Address
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Address Line | PO BOX 3564
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City | SIOUX CITY
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State | IA
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Zip | 51102-3564
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Country | US
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Telephone | 712-226-3937
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Fax | 712-224-3973
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL GERARD WADZINSKI
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Credential | MD
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Telephone | 712-226-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 29715
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License Number State | IA
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