MEDICARE: JOSEPH F GAZARKIEWICZ PSY.D

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	103TC0700X	Clinical Psychologist	20042249A	IN

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	:	1548595796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH F GAZARKIEWICZ PSY.D

Provider Business Mailing Address
First Line	:	1411 S. WOODLAND AVENUE
Second Line	:	SUITE B
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-7170
Country	:	US
Telephone Number	:	219-879-8580
Fax Number	:	219-764-7025

Provider Business Practice Location Address
First Line	:	1411 S. WOODLAND AVENUE
Second Line	:	SUITE B
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-7170
Country	:	US
Telephone Number	:	219-763-1499
Fax Number	:	219-764-7025

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	04/30/2012

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