Basic Information
| Provider Information | |||||||||
| NPI: | 1588799738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAZURCZAK | ||||||||
| FirstName: | WIOLETA | ||||||||
| MiddleName: | ELZBIETA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NEWPORANY | ||||||||
| OtherFirstName: | WIOLETA | ||||||||
| OtherMiddleName: | ELZBIETA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 W 69TH ST | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053225700 | ||||||||
| FaxNumber: | 6053225704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 7102 | SD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 12200 | 05 | ND | MEDICAID | 1588799738 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 708402000 | 05 | MN | MEDICAID | 7101960 | 05 | SD | MEDICAID | 412991052723 | 01 | SD | PREFERRED ONE | OTHER | 4992668 | 01 | SD | BCBS SOUTH DAKOTA | OTHER | 46022474352 | 05 | NE | MEDICAID | 040121002 | 01 | PRIMEWEST | OTHER | 370624200 | 01 | DEPT. OF LABOR | OTHER | 57108C036 | 01 | SD | WPS TRICARE | OTHER | 61408 | 01 | SANFORD HEALTH PLAN | OTHER | 7102 | 01 | SD | DAKOTACARE | OTHER | HP83890 | 01 | SD | HEALTHPARTNERS | OTHER | 254722 | 01 | SD | MIDLAND'S CHOICE | OTHER | 6I497MA | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 6I497MA | 01 | MN | BLUE PLUS | OTHER |