Individual
MATTHEW T CZERNIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3801 SPRING ST, RACINE, WI 53405-1667
(262) 687-4479
Mailing address
3805B SPRING ST, SUITE #230, RACINE, WI 53405-1641
(262) 687-4479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2489-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2489-023
WISCONSIN LICENSE
WI
Enumeration date
08/18/2009
Last updated
08/18/2009
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