Provider Demographics
NPI:1639113749
Name:CZARNIK, TAMARACK ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARACK
Middle Name:ROBERT
Last Name:CZARNIK
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:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254-0307
Mailing Address - Country:US
Mailing Address - Phone:701-322-4347
Mailing Address - Fax:701-322-2244
Practice Address - Street 1:108 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCVILLE
Practice Address - State:ND
Practice Address - Zip Code:58254-0307
Practice Address - Country:US
Practice Address - Phone:701-322-4347
Practice Address - Fax:701-322-2244
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5243A207Q00000X
ND7329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F76296Medicare UPIN