Provider Demographics
NPI:1861424236
Name:WALCZAK, DARIUSZ (MD)
Entity type:Individual
Prefix:
First Name:DARIUSZ
Middle Name:
Last Name:WALCZAK
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 1:14416 33RD DR SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5028
Mailing Address - Country:US
Mailing Address - Phone:425-350-8481
Mailing Address - Fax:425-357-0941
Practice Address - Street 1:14416 33RD DR SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5028
Practice Address - Country:US
Practice Address - Phone:425-350-8481
Practice Address - Fax:425-357-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035997207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5642WAOtherB/S REGENCE 90
WA8243529Medicaid
189643OtherL&I
189643OtherL&I
WA8243529Medicaid
DD0357Medicare ID - Type UnspecifiedRR