1306885215 NPI number — MR. PRZEMYSLAW KONRAD NIEMCZURA RD

Table of content: MR. PRZEMYSLAW KONRAD NIEMCZURA RD (NPI 1306885215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306885215 NPI number — MR. PRZEMYSLAW KONRAD NIEMCZURA RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEMCZURA
Provider First Name:
PRZEMYSLAW
Provider Middle Name:
KONRAD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306885215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 41 BOX 2563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
011441638528124
Provider Business Mailing Address Fax Number:
011441638528022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 MEDICAL GROUP
Provider Second Line Business Practice Location Address:
UNIT 5210
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
011441638528124
Provider Business Practice Location Address Fax Number:
011441638528022
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  886882 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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