Provider Demographics
NPI:1073539847
Name:KOBYLANSKI, TOMASZ (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMASZ
Middle Name:
Last Name:KOBYLANSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 DIXIE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-1303
Mailing Address - Country:US
Mailing Address - Phone:502-333-3121
Mailing Address - Fax:502-531-9538
Practice Address - Street 1:8019 DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-1303
Practice Address - Country:US
Practice Address - Phone:502-333-3121
Practice Address - Fax:502-531-9538
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058945A207R00000X
KY37572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100180890GMedicaid
IN200400730Medicaid
IN200400730Medicaid
IN940280E8Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE#
IN940280Medicare ID - Type UnspecifiedMEDICARE GRP #
IN200400730Medicaid