Provider Demographics
NPI:1508486507
Name:WRZESINSKI, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:WRZESINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HIGHWAY
Mailing Address - Street 2:PSYCHIATRY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-3932
Mailing Address - Country:US
Mailing Address - Phone:318-626-2445
Mailing Address - Fax:
Practice Address - Street 1:1501 KINGS HIGHWAY
Practice Address - Street 2:PSYCHIATRY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71130-3932
Practice Address - Country:US
Practice Address - Phone:318-626-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program