Theodore M Wandzilak MD

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

22152 Issued in KY

Legal business name

THEODORE M WANDZILAK MD

Practice address

1348 Poplar Level Rd
Louisville, KY 40217-1307

Phone

(502) 634-1721

Fax

(502) 637-6396

NPI assigned

Jan 30, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pam Smith

Title

Manager

Phone

(502) 634-1721

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1033396171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1348 POPLAR LEVEL RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171307",
            "telephone_number": "502-634-1721",
            "fax_number": "502-637-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 POPLAR LEVEL RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171307",
            "telephone_number": "502-634-1721",
            "fax_number": "502-637-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE M WANDZILAK MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "502-634-1721"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "22152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Louisville, KY
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• Durable Medical Equipment & Medical Supplies in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.