MEDICARE: BERNARD ZAWORSKI 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	207Q00000X	Family Medicine Physician	39479020	WI

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	:	1568437390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD ZAWORSKI MD

Provider Business Mailing Address
First Line	:	PO BOX 1239
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48099-1239
Country	:	US
Telephone Number	:	248-824-6600
Fax Number	:	248-324-1477

Provider Business Practice Location Address
First Line	:	2514 S 102ND ST
Second Line	:	SUITE 160
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-2142
Country	:	US
Telephone Number	:	414-255-0300
Fax Number	:	414-543-9601

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	10/13/2011

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