Provider Demographics
NPI:1972598696
Name:MORAWIECKI, PETER ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:MORAWIECKI
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 1:33173 N COVE RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2104
Mailing Address - Country:US
Mailing Address - Phone:847-223-5161
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC GREAT LAKES, LABORATORY DEPT
Practice Address - Street 2:3001 A SIXTH ST
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053664207ZP0102X
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology