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NPI Code Detail

MEDICARE: DR. NATHAN MATTHEW WNUK M.D.

MEDICARE: DR. NATHAN MATTHEW WNUK M.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
12085R0204XVascular & Interventional Radiology Physician6971091ID
22085R0202XDiagnostic Radiology Physician36290WV
32085R0204XVascular & Interventional Radiology Physician57732AZ
42085R0202XDiagnostic Radiology Physician57732AZ
52085R0202XDiagnostic Radiology PhysicianR7145TX

General Provider Information

NPI Number : 1558700716
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHAN MATTHEW WNUK M.D.
Provider Business Mailing Address
First Line : 1911 HOLCOMBE BLVD APT 906
Second Line :
City : HOUSTON
State : TX
Zip : 77030-4183
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2400 S AVENUE A
Second Line :
City : YUMA
State : AZ
Zip : 85364-7170
Country : US
Telephone Number : 928-336-1759
Fax Number : 928-336-1758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2013
Last Update Date : 04/07/2026

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