1679541999 NPI number — MICHAEL JOSEPH KRZYZKOWSKI M.D.

Table of content: MICHAEL JOSEPH KRZYZKOWSKI M.D. (NPI 1679541999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679541999 NPI number — MICHAEL JOSEPH KRZYZKOWSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRZYZKOWSKI
Provider First Name:
MICHAEL
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1679541999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5955 RAND BLVD.
Provider Second Line Business Mailing Address:
TIDEWELL HOSPICE AND PALLIATIVE CARE
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34238-5160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-923-5822
Provider Business Mailing Address Fax Number:
941-925-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5955 RAND BLVD.
Provider Second Line Business Practice Location Address:
TIDEWELL HOSPICE AND PALLIATIVE CARE
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34238-5160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-923-5822
Provider Business Practice Location Address Fax Number:
941-925-0969
Provider Enumeration Date:
03/11/2006

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: 207Q00000X , with the licence number:  ME91548 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25654 . This is a "UNITED HEATLHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 301386 . This is a "WELLCARE URGENT CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 214490 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 229615 . This is a "AMERIGROUP URGENT CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 311532 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 04690 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00183786 . This is a "RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271419100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01019 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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