Provider Demographics
NPI:1124166327
Name:JOANNA GALEZOWSKA MD. SC
Entity type:Organization
Organization Name:JOANNA GALEZOWSKA MD. SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GALEZOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-961-5550
Mailing Address - Street 1:2015 E NEWPORT AVE
Mailing Address - Street 2:308
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2984
Mailing Address - Country:US
Mailing Address - Phone:414-961-5550
Mailing Address - Fax:414-961-4669
Practice Address - Street 1:2015 E NEWPORT AVE
Practice Address - Street 2:308
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2984
Practice Address - Country:US
Practice Address - Phone:414-961-5550
Practice Address - Fax:414-961-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31941800Medicaid
F60106Medicare UPIN