MEDICARE: MICHAEL JAWORSKY

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	247100000X	Radiologic Technologist	303382
2	2471S1302X	Sonography Radiologic Technologist	79559

General Provider Information

NPI Number	:	1386036960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAWORSKY

Provider Business Mailing Address
First Line	:	2700 SW 115TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 SW 115TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2630
Country	:	US
Telephone Number	:	940-867-4505
Fax Number	:

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

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	02/19/2015

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Directions to “ MICHAEL JAWORSKY ” Practice Location

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