MEDICARE: EUGENE WAWRZYNIAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME39665	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160041145	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0877387002	OTHER	FL	CIGNA
4	0494928	OTHER	FL	AETNA
5	22815	OTHER	FL	WELLCARE
6	4038991	OTHER	FL	AETNA
7	05457	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1053397141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE WAWRZYNIAK MD

Provider Business Mailing Address
First Line	:	2575 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4126
Country	:	US
Telephone Number	:	321-454-7148
Fax Number	:	321-449-5015

Provider Business Practice Location Address
First Line	:	1051 PORT MALABAR BLVD NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-5153
Country	:	US
Telephone Number	:	321-676-0555
Fax Number	:	321-676-0700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	12/10/2012

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Directions to “ EUGENE WAWRZYNIAK MD” Practice Location

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