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General NPI Number Information
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NPI Number | 1912277906
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Entity Type | Organization
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Legal Business Name | THOMAS J SHEWCZYK MD SC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 4922 COLUMBIA RD SUITE 100
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City | CEDARBURG
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State | WI
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Zip | 53012-9188
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Country | US
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Telephone | 262-375-1580
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Fax | 262-375-9452
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Provider Business Mailing Address
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Address Line | 4922 COLUMBIA RD SUITE 100
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City | CEDARBURG
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State | WI
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Zip | 53012-9188
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Country | US
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Telephone | 262-375-1580
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Fax | 262-375-9452
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS JOHN SHEWCZYK
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Credential | M.D.
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Telephone | 262-375-1580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 19364
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License Number State | WI
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