Provider Demographics
NPI:1093768434
Name:KLYMIUK, JADWIGA A (MD)
Entity Type:Individual
Prefix:
First Name:JADWIGA
Middle Name:A
Last Name:KLYMIUK
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:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-702-4151
Practice Address - Fax:817-702-4161
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL54162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00275252OtherRAILROAD MEDICARE
TX158291803Medicaid
TX8U1298OtherBCBS
TXP00275252OtherRAILROAD MEDICARE
TXH84246Medicare UPIN