Provider Demographics
NPI:1164472635
Name:WENCZAK, BARBARA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNE
Last Name:WENCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12200 W COLONIAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4125
Mailing Address - Country:US
Mailing Address - Phone:407-877-1026
Mailing Address - Fax:407-877-1028
Practice Address - Street 1:12200 W COLONIAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4125
Practice Address - Country:US
Practice Address - Phone:407-877-1026
Practice Address - Fax:407-877-1028
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL69776208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28371OtherBLUE CROSS BLUE SHIELD
GU593696464OtherCIGNA
FL593696464OtherHUMANA
FL593696464OtherUNITED HEALTH CARE
FL593696464OtherTRICARE
FL240007590OtherRAILROAD MEDICARE
FL593696464OtherTRICARE
FL593696464OtherTRICARE