Provider Demographics
NPI:1386831568
Name:CZESNOWSKI, PATRYCJA IZABELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRYCJA
Middle Name:IZABELLA
Last Name:CZESNOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24503 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1141
Mailing Address - Country:US
Mailing Address - Phone:248-629-6440
Mailing Address - Fax:248-629-6445
Practice Address - Street 1:24503 JOHN R RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1141
Practice Address - Country:US
Practice Address - Phone:248-629-6440
Practice Address - Fax:248-629-6445
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396839981Medicaid
MI1871645309Medicaid
MI1144371279Medicaid