Provider Demographics
NPI:1720011984
Name:JEDRZEJCZAK, DOROTA WALKIEWICZ (MD)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:WALKIEWICZ
Last Name:JEDRZEJCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOROTA
Other - Middle Name:
Other - Last Name:WALKIEWICZ-JEDRZEJCZAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-6420
Practice Address - Fax:608-263-0440
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI409192080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology