Provider Demographics
NPI:1588799738
Name:MAZURCZAK, WIOLETA ELZBIETA (MD)
Entity Type:Individual
Prefix:
First Name:WIOLETA
Middle Name:ELZBIETA
Last Name:MAZURCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WIOLETA
Other - Middle Name:ELZBIETA
Other - Last Name:NEWPORANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD71022084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12200Medicaid
SD1588799738OtherARAZ/ AMERICA'S PPO
MN708402000Medicaid
SD7101960Medicaid
SD412991052723OtherPREFERRED ONE
SD4992668OtherBCBS SOUTH DAKOTA
NE46022474352Medicaid
040121002OtherPRIMEWEST
370624200OtherDEPT. OF LABOR
SD57108C036OtherWPS TRICARE
61408OtherSANFORD HEALTH PLAN
SD7102OtherDAKOTACARE
SDHP83890OtherHEALTHPARTNERS
SD254722OtherMIDLAND'S CHOICE
MN6I497MAOtherCC SYSTEMS/ BLUE PLUS
MN6I497MAOtherBLUE PLUS
SD1588799738OtherARAZ/ AMERICA'S PPO