Individual
MICHAEL WIECZORKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
400 CONCORD PLAZA DR STE 300, SAN ANTONIO, TX 78216-6991
(210) 804-5911
Mailing address
400 CONCORD PLAZA DR STE 300, SAN ANTONIO, TX 78216-6991
(210) 804-5911
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT5781
TX
363AM0700X
Medical Physician Assistant
Primary
PA17404
TX
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/02/2017
Last updated
11/06/2023
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