Provider Demographics
NPI:1669790390
Name:PAUL B WIZMAN MD, PA
Entity type:Organization
Organization Name:PAUL B WIZMAN MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:WIZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-969-1355
Mailing Address - Street 1:5800 COLONIAL DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5682
Mailing Address - Country:US
Mailing Address - Phone:954-969-1355
Mailing Address - Fax:954-969-1232
Practice Address - Street 1:5800 COLONIAL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5682
Practice Address - Country:US
Practice Address - Phone:954-969-1355
Practice Address - Fax:954-969-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32282AMedicare UPIN