Provider Demographics
NPI:1629056957
Name:MACHNOWSKI, WIESLAW (MD)
Entity Type:Individual
Prefix:
First Name:WIESLAW
Middle Name:
Last Name:MACHNOWSKI
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 1:701 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1251
Mailing Address - Country:US
Mailing Address - Phone:319-368-7900
Mailing Address - Fax:319-368-5690
Practice Address - Street 1:701 10TH ST SE # LEVEL4
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-861-7900
Practice Address - Fax:319-861-7950
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1629056957Medicaid
IA0109330Medicaid
IAF92984Medicare UPIN
IA1629056957Medicaid
IA0109330Medicaid