Provider Demographics
NPI:1164817573
Name:ANDREW J. WOLSZCZAK, M.D.
Entity Type:Organization
Organization Name:ANDREW J. WOLSZCZAK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WOLSZCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-743-6526
Mailing Address - Street 1:8151 OVERSEAS HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3200
Mailing Address - Country:US
Mailing Address - Phone:305-743-6526
Mailing Address - Fax:305-743-4070
Practice Address - Street 1:8151 OVERSEAS HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3200
Practice Address - Country:US
Practice Address - Phone:305-743-6526
Practice Address - Fax:305-743-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D27221Medicare UPIN
78864Medicare PIN