Provider Demographics
NPI:1053311829
Name:WIRASZKA, ADAM (MD PHD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WIRASZKA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:STE 460
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4107
Mailing Address - Country:US
Mailing Address - Phone:361-980-0353
Mailing Address - Fax:361-980-1120
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:STE 460
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4107
Practice Address - Country:US
Practice Address - Phone:361-980-0353
Practice Address - Fax:361-980-1120
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149468401Medicaid
H85690Medicare UPIN