Provider Demographics
NPI:1720842917
Name:GWIAZDOWSKI, COLIN THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:THOMAS
Last Name:GWIAZDOWSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MAIN ST
Mailing Address - Street 2:#221
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:78660
Mailing Address - Country:US
Mailing Address - Phone:610-781-3068
Mailing Address - Fax:
Practice Address - Street 1:515 WALNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1621
Practice Address - Country:US
Practice Address - Phone:812-909-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant