Provider Demographics
NPI:1154349546
Name:SAWCZAK, TONI ALEXIS (MD)
Entity type:Individual
Prefix:MS
First Name:TONI
Middle Name:ALEXIS
Last Name:SAWCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 NE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-6441
Mailing Address - Country:US
Mailing Address - Phone:772-334-2444
Mailing Address - Fax:772-334-4122
Practice Address - Street 1:2050 NE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-6441
Practice Address - Country:US
Practice Address - Phone:772-334-2444
Practice Address - Fax:772-334-4122
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372256200Medicaid
FL02214ZMedicare PIN
FL372256200Medicaid