MEDICARE: DR. JEFFREY ROBERT WESOLOWSKI MD, MHSA

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	2085N0700X	Neuroradiology Physician	MD60703635	WA
2	2085N0700X	Neuroradiology Physician	MD180766	OR
3	2085R0202X	Diagnostic Radiology Physician	MD180766	OR
4	2085R0202X	Diagnostic Radiology Physician	MD60703635	WA
5	2085R0202X	Diagnostic Radiology Physician	76717	TN
6	2085R0202X	Diagnostic Radiology Physician	D0063047	MD
7	2085N0700X	Neuroradiology Physician	4301089073	MI
8	2085R0202X	Diagnostic Radiology Physician	4301089073	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J062	OTHER	MD	B/C B/S
2	2849	OTHER	MD	B/C B/S
3	KA80	OTHER	MD	B/C B/S
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962474163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ROBERT WESOLOWSKI MD, MHSA

Provider Business Mailing Address
First Line	:	1304 FAWCETT AVE STE 100
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-1900
Country	:	US
Telephone Number	:	253-761-4200
Fax Number	:	253-761-4201

Provider Business Practice Location Address
First Line	:	1500 EAST MEDICAL CENTER DR
Second Line	:	B1 FLOOR UNIVERSITY HOSPITAL RECP C
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-5030
Country	:	US
Telephone Number	:	734-936-4566
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	02/05/2026

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