Provider Demographics
NPI:1790005585
Name:PAOLA D WIERNIK MD PLLC
Entity Type:Organization
Organization Name:PAOLA D WIERNIK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WIERNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-668-0700
Mailing Address - Street 1:4412 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2480
Mailing Address - Country:US
Mailing Address - Phone:956-668-0700
Mailing Address - Fax:956-668-0710
Practice Address - Street 1:4412 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2480
Practice Address - Country:US
Practice Address - Phone:956-668-0700
Practice Address - Fax:956-668-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK3878OtherTEXAS STATE LICENSE
TXG50532Medicare UPIN