Provider Demographics
NPI:1659380939
Name:IWASZKO, MARKIAN R (MD)
Entity Type:Individual
Prefix:
First Name:MARKIAN
Middle Name:R
Last Name:IWASZKO
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 1:1000 E PARIS AVE SE STE 230
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-949-4340
Mailing Address - Fax:616-949-4341
Practice Address - Street 1:1000 E PARIS AVE SE STE 230
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3680
Practice Address - Country:US
Practice Address - Phone:616-949-4340
Practice Address - Fax:616-949-4341
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095939208800000X
IN01089840A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI34OD160430OtherBCBSM
I58780Medicare UPIN