Individual
CHARLES K WANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
245 S COURTENAY PARKWAY, BLDG B, MERRITT ISLAND, FL 32952
(321) 453-5326
(321) 452-8507
Mailing address
245 S COURTENAY PARKWAY, BLDG B, MERRITT ISLAND, FL 32952
(321) 453-5326
(321) 452-8507
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME36933
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039647800
—
FL
01
—
110202974
RR MEDICARE
—
01
—
2168973
AETNA
—
Enumeration date
09/22/2006
Last updated
10/26/2011
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