Provider Demographics
NPI:1124009436
Name:FRATCZAK, SLAWOMIR MARK (MD)
Entity Type:Individual
Prefix:
First Name:SLAWOMIR
Middle Name:MARK
Last Name:FRATCZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MERCY DR NW
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2626
Mailing Address - Country:US
Mailing Address - Phone:330-580-4706
Mailing Address - Fax:330-580-4707
Practice Address - Street 1:1330 MERCY DR NW
Practice Address - Street 2:SUITE 510
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2626
Practice Address - Country:US
Practice Address - Phone:330-580-4706
Practice Address - Fax:330-580-4707
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073829F207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2140749Medicaid
OH0877241Medicare ID - Type Unspecified
OH2140749Medicaid