Provider Demographics
NPI:1861629172
Name:MROCZKOWSKI, HENRY JOEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:JOEL
Last Name:MROCZKOWSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 N DUNLAP ST
Mailing Address - Street 2:FACULTY OFFICE BUILDING - 144
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2802
Mailing Address - Country:US
Mailing Address - Phone:901-448-6491
Mailing Address - Fax:901-448-4117
Practice Address - Street 1:51 N DUNLAP ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-287-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53440207SG0201X, 207Q00000X
PAMD444907207Q00000X, 207SG0201X
ARE-7267207Q00000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine