Individual
IZABELA WASILUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
655 W 8TH ST, ANESTHESIA DEPT., JACKSONVILLE, FL 32209-6511
(904) 244-5431
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME82091
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000911666A
—
GA
01
—
050082215
RR CARE
—
05
—
2617498-00
—
FL
Enumeration date
02/08/2006
Last updated
07/16/2010
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