Organization
JEFFREY WISNICKI, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WISNICKI M.D. (PRESIDENT)
(561) 798-1400
Entity
Organization
Contact information
Practice address
13005 SOUTHERN BLVD, SUITE 133, LOXAHATCHEE, FL 33470-9206
(561) 798-1400
(561) 798-0255
Mailing address
13005 SOUTHERN BLVD, SUITE 133, LOXAHATCHEE, FL 33470-9206
(561) 798-1400
(561) 798-0255
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
ME 48094
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154406080
NPI FOR INDIVIDUAL PRACTITIONER (JEFFREY L. WISNICKI, M.D.)
FL
Enumeration date
08/12/2013
Last updated
08/12/2013
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