Basic Information
| Provider Information | |||||||||
| NPI: | 1295912509 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOJCIECH ZOLCIK M.D. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7060 | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076741720 | ||||||||
| FaxNumber: | 3076877243 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 W BRUNDAGE ST | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828014217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076741665 | ||||||||
| FaxNumber: | 3076877243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZOLCIK | ||||||||
| AuthorizedOfficialFirstName: | WOJCIECH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3076741665 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 6219A | WY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 115107000 | 05 | WY | MEDICAID |