Provider Demographics
NPI:1568575629
Name:CZERWONKA, GRAZYNA GRACE (MD)
Entity Type:Individual
Prefix:
First Name:GRAZYNA
Middle Name:GRACE
Last Name:CZERWONKA
Suffix:
Gender:F
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:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-2249
Mailing Address - Fax:920-320-3529
Practice Address - Street 1:2300 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3712
Practice Address - Country:US
Practice Address - Phone:920-320-2249
Practice Address - Fax:920-320-3529
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39618207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32633600Medicaid
WI3908063950H8OtherBLUE CROSS BLUE SHIELD
WI050071232OtherMEDICARE RAILROAD
WI003900205Medicare ID - Type Unspecified
WI32633600Medicaid