Provider Demographics
NPI:1013976166
Name:WOJTUSIAK, DANIEL GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GEORGE
Last Name:WOJTUSIAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAHC-HANAU
Mailing Address - Street 2:CMR 470 BOX 4862
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09165
Mailing Address - Country:DE
Mailing Address - Phone:0114-950-0328
Mailing Address - Fax:6668
Practice Address - Street 1:USAHC-HANAU
Practice Address - Street 2:CMR 470 BOX 4862
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09165
Practice Address - Country:DE
Practice Address - Phone:0114-950-0328
Practice Address - Fax:6668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002754A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice