Provider Demographics
NPI:1083855316
Name:WOJCIECH ZOLCIK, M.D., P.C.
Entity Type:Organization
Organization Name:WOJCIECH ZOLCIK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISMICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-202-7761
Mailing Address - Street 1:113 S GILLETTE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3740
Mailing Address - Country:US
Mailing Address - Phone:402-202-7761
Mailing Address - Fax:307-460-7417
Practice Address - Street 1:113 S GILLETTE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3740
Practice Address - Country:US
Practice Address - Phone:402-202-7761
Practice Address - Fax:307-460-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6219A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115107000Medicaid
WYG88398Medicare UPIN