Provider Demographics
NPI:1063514784
Name:KAWALEK, WAYNE K (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:K
Last Name:KAWALEK
Suffix:
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 1:7601 FIRST PL STE 7A
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6702
Mailing Address - Country:US
Mailing Address - Phone:440-552-9454
Mailing Address - Fax:
Practice Address - Street 1:7601 FIRST PL
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6716
Practice Address - Country:US
Practice Address - Phone:440-552-9454
Practice Address - Fax:440-945-6368
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-6206207P00000X
OHAK35046206207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056326Medicaid
OHA80501Medicare UPIN
OHKA7305021Medicare ID - Type Unspecified