Provider Demographics
NPI:1942238696
Name:WOZNIEWICZ, DOROTA (MD)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:
Last Name:WOZNIEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BRIDGET CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:WI
Mailing Address - Zip Code:53125-1486
Mailing Address - Country:US
Mailing Address - Phone:262-275-3769
Mailing Address - Fax:
Practice Address - Street 1:9200 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8887
Practice Address - Country:US
Practice Address - Phone:414-529-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34245400Medicaid
WIG61971Medicare UPIN