Provider Demographics
NPI:1093105249
Name:KRZYSZTOF T LEWANDOWSKI MD
Entity Type:Organization
Organization Name:KRZYSZTOF T LEWANDOWSKI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRZYSZTOF
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-9969
Mailing Address - Street 1:2101 NORTHSIDE DR
Mailing Address - Street 2:601
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3687
Mailing Address - Country:US
Mailing Address - Phone:850-747-9969
Mailing Address - Fax:850-747-1052
Practice Address - Street 1:2101 NORTHSIDE DR
Practice Address - Street 2:601
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3687
Practice Address - Country:US
Practice Address - Phone:850-747-9969
Practice Address - Fax:850-747-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250359001Medicaid
FLG11978Medicare UPIN
FL32210AMedicare PIN