Provider Demographics
NPI:1942472915
Name:JEZIORCZAK, PAUL MICHAEL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:JEZIORCZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:MEDICAL COLLEGE OF WISCONSIN DEPARTMENT OF SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:708-431-3899
Mailing Address - Fax:414-259-9225
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:MEDICAL COLLEGE OF WISCONSIN DEPARTMENT OF SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:708-431-3899
Practice Address - Fax:414-259-9225
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program