Provider Demographics
NPI:1437284510
Name:KASZNICA, PETER P (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:KASZNICA
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 1:2315 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5046
Mailing Address - Country:US
Mailing Address - Phone:605-336-3503
Mailing Address - Fax:605-336-6010
Practice Address - Street 1:2315 W 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5046
Practice Address - Country:US
Practice Address - Phone:605-336-3503
Practice Address - Fax:605-336-6010
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7876207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00902539OtherRAILROAD MEDICARE
SDS104554Medicare PIN