Provider Demographics
NPI:1164538674
Name:WANZEK, JOSEPH M III (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:WANZEK
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 W BROADWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3291
Mailing Address - Country:US
Mailing Address - Phone:712-325-0022
Mailing Address - Fax:
Practice Address - Street 1:3434 W BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3291
Practice Address - Country:US
Practice Address - Phone:712-325-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008621207Q00000X
MI5101016678207Q00000X
IA3861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine