Individual
DR. CHARLES JOHN GWIZDALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5087 N ROYAL DR, TRAVERSE CITY, MI 49684-6987
(231) 935-0440
(231) 935-0445
Mailing address
5087 N ROYAL DR, TRAVERSE CITY, MI 49684-6987
(231) 935-0440
(231) 935-0445
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301051700
MI
207RP1001X
Pulmonary Disease Physician
Primary
4301051700
MI
207RS0012X
Sleep Medicine (Internal Medicine) Physician
4301051700
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B81008
BCBS
MI
01
—
290008345
RAILROAD MEDICARE
MI
05
—
3307861
—
MI
Enumeration date
06/30/2005
Last updated
10/14/2019
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