Provider Demographics
NPI:1790801660
Name:MICHAEL J ZAWISZA, DO, PC
Entity Type:Organization
Organization Name:MICHAEL J ZAWISZA, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWISZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-385-3826
Mailing Address - Street 1:523 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-1107
Mailing Address - Country:US
Mailing Address - Phone:570-385-3826
Mailing Address - Fax:570-385-4125
Practice Address - Street 1:523 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-1107
Practice Address - Country:US
Practice Address - Phone:570-385-3826
Practice Address - Fax:570-385-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010041265OtherTRAVELERS MEDICARE
563795OtherHIGHMARK BS