Provider Demographics
NPI:1861422461
Name:VONZIELINSKI, THEODOR V B I (MD)
Entity type:Individual
Prefix:DR
First Name:THEODOR
Middle Name:V B
Last Name:VONZIELINSKI
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-794-1450
Practice Address - Street 1:1050 37TH PL
Practice Address - Street 2:SUITE 101 & 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6578
Practice Address - Country:US
Practice Address - Phone:772-770-6116
Practice Address - Fax:772-564-6120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037467174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006326700Medicaid
FL31156OtherBCBS
FL31156YMedicare PIN
FL31156OtherBCBS