Provider Demographics
NPI:1053318923
Name:KACZMARSKA, BARBARA F (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:F
Last Name:KACZMARSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 COLLOREDO BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2774
Mailing Address - Country:US
Mailing Address - Phone:931-685-8111
Mailing Address - Fax:931-680-1050
Practice Address - Street 1:880 COLLOREDO BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2774
Practice Address - Country:US
Practice Address - Phone:931-685-8111
Practice Address - Fax:931-680-1050
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD281272080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3803699Medicaid
TN3803699Medicare ID - Type Unspecified
TN3803699Medicaid