Provider Demographics
NPI:1295827483
Name:DLUGOSZ, KRZYSZTOF (PT)
Entity Type:Individual
Prefix:MR
First Name:KRZYSZTOF
Middle Name:
Last Name:DLUGOSZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11595 E LAKEWOOD BLVD
Mailing Address - Street 2:SUITE 80
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8695
Mailing Address - Country:US
Mailing Address - Phone:616-594-2000
Mailing Address - Fax:616-594-2004
Practice Address - Street 1:11595 E LAKEWOOD BLVD
Practice Address - Street 2:SUITE 80
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8695
Practice Address - Country:US
Practice Address - Phone:616-594-2000
Practice Address - Fax:616-594-2004
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL738220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN74750007Medicare PIN