Provider Demographics
NPI:1528131711
Name:WANSKI, ZDZISLAUS JOSEPH (MD)
Entity type:Individual
Prefix:MR
First Name:ZDZISLAUS
Middle Name:JOSEPH
Last Name:WANSKI
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 1:1150 STATE HWY 248 SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-348-8990
Mailing Address - Fax:417-348-8090
Practice Address - Street 1:1150 STATE HWY 248 SUITE 102
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-348-8990
Practice Address - Fax:417-348-8090
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36872207RE0101X
MO2016030291207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083400Medicaid
CAGR0083400Medicaid
A46846Medicare UPIN