Provider Demographics
NPI:1518958412
Name:KRASZEWSKA-OSTROMECKA, ELZBIETA E (MD)
Entity Type:Individual
Prefix:
First Name:ELZBIETA
Middle Name:E
Last Name:KRASZEWSKA-OSTROMECKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELZBIETA
Other - Middle Name:
Other - Last Name:OSTROMECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:415 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2431
Mailing Address - Country:US
Mailing Address - Phone:208-799-5522
Mailing Address - Fax:208-750-7516
Practice Address - Street 1:341 SAINT JOHNS WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2436
Practice Address - Country:US
Practice Address - Phone:208-750-7462
Practice Address - Fax:208-750-7467
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34845-020207R00000X
IDM-13537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31984800Medicaid
WI31984800Medicaid
WI68091Medicare ID - Type Unspecified