Provider Demographics
NPI:1386676971
Name:ROZEK, MAREK J (PA-C)
Entity Type:Individual
Prefix:
First Name:MAREK
Middle Name:J
Last Name:ROZEK
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:391-272-5000
Practice Address - Fax:319-272-6775
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA01652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAQ52410Medicare UPIN
IAI16019Medicare PIN