Provider Demographics
NPI:1942356860
Name:RUSSELL J. WOJCIK, D.P.M., INC
Entity Type:Organization
Organization Name:RUSSELL J. WOJCIK, D.P.M., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:213-385-1266
Mailing Address - Street 1:12807 ELKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2035
Mailing Address - Country:US
Mailing Address - Phone:213-385-1266
Mailing Address - Fax:
Practice Address - Street 1:419 1/2 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3013
Practice Address - Country:US
Practice Address - Phone:213-385-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE19200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E19200Medicaid
CAWE1920AMedicare PIN
CA000E19200Medicaid
CAE1920Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
CAT19148Medicare UPIN