Provider Demographics
NPI:1366551293
Name:WOJCIECH A. GADOWSKI, MD, SC
Entity type:Organization
Organization Name:WOJCIECH A. GADOWSKI, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:DUNSIRN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-720-0782
Mailing Address - Street 1:333 1ST ST STE C
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-3080
Mailing Address - Country:US
Mailing Address - Phone:920-725-7726
Mailing Address - Fax:920-725-7898
Practice Address - Street 1:314 RACINE ST
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-2337
Practice Address - Country:US
Practice Address - Phone:920-729-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty