Provider Demographics
NPI:1235101478
Name:BARCZAK, GREGORY (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BARCZAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W180N7950 TOWN HALL RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4049
Mailing Address - Country:US
Mailing Address - Phone:252-255-2500
Mailing Address - Fax:
Practice Address - Street 1:W180N7950 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4049
Practice Address - Country:US
Practice Address - Phone:252-255-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI635213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43214900Medicaid
WIU18657Medicare UPIN
WI0194Medicare ID - Type Unspecified