Provider Demographics
NPI:1407159692
Name:PATRICK A. KRZYZEWSKI, D.P.M.
Entity Type:Organization
Organization Name:PATRICK A. KRZYZEWSKI, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:KRZYZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-546-3100
Mailing Address - Street 1:7635 W OKLAHOMA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3600
Mailing Address - Country:US
Mailing Address - Phone:414-546-3100
Mailing Address - Fax:414-546-1881
Practice Address - Street 1:7635 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-3600
Practice Address - Country:US
Practice Address - Phone:414-546-3100
Practice Address - Fax:414-546-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI477-25332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053496067OtherNPI-PRACTITIONER
WI30016800Medicaid
WI30016800Medicaid
T62501Medicare UPIN
WI30016800Medicaid