Provider Demographics
NPI:1033145966
Name:KWIECINSKI, DARIUSZ ANDRZEJ (PT)
Entity Type:Individual
Prefix:
First Name:DARIUSZ
Middle Name:ANDRZEJ
Last Name:KWIECINSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7349
Mailing Address - Country:US
Mailing Address - Phone:903-957-0385
Mailing Address - Fax:903-957-4006
Practice Address - Street 1:301 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7349
Practice Address - Country:US
Practice Address - Phone:903-957-0385
Practice Address - Fax:903-957-4006
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081404174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86916TOtherBCBS
TX152780601Medicaid
TX8273B8Medicare ID - Type Unspecified