MEDICARE: DR. PETER ANDREW MORAWIECKI 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01053664	IN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician		IL

General Provider Information

NPI Number	:	1972598696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ANDREW MORAWIECKI MD

Provider Business Mailing Address
First Line	:	33173 N COVE RD
Second Line	:
City	:	WILDWOOD
State	:	IL
Zip	:	60030-2104
Country	:	US
Telephone Number	:	847-223-5161
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL HEALTH CLINIC GREAT LAKES, LABORATORY DEPT
Second Line	:	3001 A SIXTH ST
City	:	GREAT LAKES
State	:	IL
Zip	:	60088
Country	:	US
Telephone Number	:	847-688-4880
Fax Number	:

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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