Individual
THADDEUS STANLEY WALCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
40359
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01014968
PREFERRED ONE
—
01
—
05-81578
MEDICA
—
05
—
10088
—
ND
01
—
130018102
RAILROAD MEDICARE
—
01
—
31Q17WA
BLUE CROSS BLUE SHIELD
MN
05
—
338516700
—
MN
01
—
41-1677590
1ST CHOICE OF THE MIDWEST
—
01
—
792831
AMERICAS PPO
—
01
—
A011
TRIWEST
—
01
—
HP7170
HEALTHPARTNERS
—
Enumeration date
07/22/2006
Last updated
09/21/2011
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