Provider Demographics
NPI:1942213996
Name:FLORCZAK, JONATHAN W (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:W
Last Name:FLORCZAK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-9719
Mailing Address - Fax:414-259-0469
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9719
Practice Address - Fax:414-259-0469
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-10-12
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Provider Licenses
StateLicense IDTaxonomies
WI495872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942213996Medicaid
WI034U 73-601Medicare PIN