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General NPI Number Information
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NPI Number | 1659860872
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Entity Type | Individual
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Provider Name | JOANNA WIECKOWSKA DO
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Gender | Female
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 1560 E SHERMAN BLVD STE 250
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City | MUSKEGON
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State | MI
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Zip | 49444-1854
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Country | US
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Telephone | 231-672-6186
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Fax | 231-672-6181
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Provider Business Mailing Address
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Address Line | PO BOX 776982
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City | CHICAGO
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State | IL
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Zip | 60677-6982
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Country | US
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Telephone | 800-494-5797
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101023799
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 5101028236
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License Number State | MI
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