Individual
JASON WIECZOREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9291 MEDICAL PLAZA DR, NORTH CHARLESTON, SC 29406-9126
(843) 764-1730
Mailing address
6800 W ARDMORE AVE, CHICAGO, IL 60631-3111
(773) 677-7066
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6155
SC
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/30/2025
Last updated
05/06/2026
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