Individual
JOHN P. MODRZYNSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
N2934 STATE ROAD 22, WAUTOMA, WI 54982-5267
(920) 787-4613
(920) 787-5433
Mailing address
122 E COLLEGE AVE, APPLETON, WI 54911-5794
(920) 787-4613
(920) 787-5433
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23162
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32833700
—
WI
Enumeration date
02/07/2006
Last updated
03/17/2018
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