Provider Demographics
NPI:1225071707
Name:KAZMIERSKI, DAVID CHESTER (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHESTER
Last Name:KAZMIERSKI
Suffix:
Gender:M
Credentials:DO
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 67070
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44222-7070
Mailing Address - Country:US
Mailing Address - Phone:330-945-4739
Mailing Address - Fax:330-945-7381
Practice Address - Street 1:3033 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3614
Practice Address - Country:US
Practice Address - Phone:330-945-4739
Practice Address - Fax:330-945-7381
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002421K207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310390Medicaid
P0012810Medicare PIN
OH0310390Medicaid
4200702Medicare PIN