MEDICARE: RUSSELL J. WOJCIK, D.P.M., INC

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	213E00000X	Podiatrist	E19200	CA

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	:	1942356860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELL J. WOJCIK, D.P.M., INC

Provider Business Mailing Address
First Line	:	12807 ELKWOOD ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-2035
Country	:	US
Telephone Number	:	213-385-1266
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 1/2 N LARCHMONT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3013
Country	:	US
Telephone Number	:	213-385-1266
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RUSSELL J WOJCIK
Credential	:	D.P.M.
Telephone Number	:	213-385-1266

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	12/12/2008

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