Provider Demographics
NPI:1164415717
Name:LEWANDOWSKI, KRZYSZTOF TADEUSZ (MD)
Entity Type:Individual
Prefix:DR
First Name:KRZYSZTOF
Middle Name:TADEUSZ
Last Name:LEWANDOWSKI
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 1:2101 NORTHSIDE DR
Mailing Address - Street 2:#601
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3685
Mailing Address - Country:US
Mailing Address - Phone:850-215-5310
Mailing Address - Fax:
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:32405-3685
Practice Address - Country:US
Practice Address - Phone:850-747-9969
Practice Address - Fax:850-747-1052
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250359001Medicaid
FL1164415717OtherNPI
FL593526861OtherTAX ID #
FL1164415717OtherNPI
FL593526861OtherTAX ID #