Provider Demographics
NPI:1083611925
Name:KURZYDLO, GRZEGORZ P (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:GRZEGORZ
Middle Name:P
Last Name:KURZYDLO
Suffix:
Gender:M
Credentials:MD, PA
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Mailing Address - Street 1:19411 MCKAY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5722
Mailing Address - Country:US
Mailing Address - Phone:281-570-4112
Mailing Address - Fax:281-570-4067
Practice Address - Street 1:19411 MCKAY DR
Practice Address - Street 2:STE 200
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5722
Practice Address - Country:US
Practice Address - Phone:281-570-4112
Practice Address - Fax:281-570-4067
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL77902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164768701Medicaid
TX7946539OtherAETNA
TXH98328Medicare UPIN
TX164768701Medicaid