Provider Demographics
NPI:1659313039
Name:ROZYCKI, MAREK ZENON (MD)
Entity type:Individual
Prefix:
First Name:MAREK
Middle Name:ZENON
Last Name:ROZYCKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:209-571-6622
Mailing Address - Fax:209-527-2069
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG411312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G411310Medicaid
CA00G411315Medicare PIN
CA00G411318Medicare PIN
CA00G4113114Medicare PIN
CA00G411316Medicare PIN
CA00G411317Medicare PIN
CA00G411319Medicare PIN
CA00G411313Medicare PIN
CA00G4113110Medicare PIN
CA00G411310Medicaid
CA00G4113113Medicare PIN
CA00G4113115Medicare PIN
CA00G411314Medicare PIN
CA00G411311Medicare PIN
CA00G411310Medicare PIN
CA00G4113111Medicare PIN
CAA48468Medicare UPIN
CA300024672Medicare PIN