MEDICARE: DR. HENRY WODNICKI 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	208C00000X	Colon & Rectal Surgery Physician	ME41122	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124010020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY WODNICKI MD

Provider Business Mailing Address
First Line	:	4306 ALTON RD
Second Line	:	COMPREHENSIVE CANCER CENTER 2ND FLOOR
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2840
Country	:	US
Telephone Number	:	305-674-2177
Fax Number	:	305-674-2176

Provider Business Practice Location Address
First Line	:	4306 ALTON RD
Second Line	:	COMPREHENSIVE CANCER CENTER 2ND FLOOR
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2840
Country	:	US
Telephone Number	:	305-674-2177
Fax Number	:	305-674-2176

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	04/10/2013

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