Provider Demographics
NPI:1437119856
Name:MROZEK, MARTIN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:M
Last Name:MROZEK
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-0957
Mailing Address - Country:US
Mailing Address - Phone:304-574-2310
Mailing Address - Fax:304-574-2311
Practice Address - Street 1:27 PARSONS LANE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-0957
Practice Address - Country:US
Practice Address - Phone:304-574-2310
Practice Address - Fax:304-574-2311
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00282213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099788000Medicaid
WV353171OtherALLIANCE PPO
WV223203OtherADVANTRA
WVP00252983OtherRR MEDICARE
WV001721891OtherMOUNTAIN STATE BC BS
WV4281890001OtherDMERC
WV0099788000Medicaid
WV353171OtherALLIANCE PPO