Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | ME109987 | FL |
NPI | 1194959643 |
---|---|
Provider Name | Dr. Joseph Michael Wierzbicki |
First Address | Port Saint Lucie, FL 34952-3405 |
Second Address | Port Saint Lucie, FL 34952-3405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 18/02/2020 |