Provider Demographics
NPI:1053496067
Name:KRZYZEWSKI, PATRICK A (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:KRZYZEWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-4410
Mailing Address - Country:US
Mailing Address - Phone:414-546-3100
Mailing Address - Fax:414-502-3398
Practice Address - Street 1:4100 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-4410
Practice Address - Country:US
Practice Address - Phone:414-546-3100
Practice Address - Fax:414-502-3398
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI477025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30016800Medicaid
AK1051729OtherDEA
82796Medicare ID - Type Unspecified
T62501Medicare UPIN
WI0301850001Medicare NSC