Provider Demographics
NPI:1760578215
Name:WOZNIAK, JEFFREY R (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:WOZNIAK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE MMC292
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 SOUT 6TH STREET
Practice Address - Street 2:SUITE F256 / 2B W
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP41832080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24G96WOOtherBLUE CROSS BLUE SHIELD
MN1022592OtherPREFERREDONE
MN61-89892OtherMEDICA - CHOICE
MN90046OtherARAZ
MN169466OtherFAIRVIEW
MN124385OtherUCARE
MNHP29901OtherHEALTHPARTNERS