Provider Demographics
NPI:1558335299
Name:PIATKOWSKI, KURT RUDIGER (DO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:RUDIGER
Last Name:PIATKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KURT
Other - Middle Name:RUDIGER
Other - Last Name:PIATKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:176 DAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9302
Mailing Address - Country:US
Mailing Address - Phone:304-645-6083
Mailing Address - Fax:
Practice Address - Street 1:203 WINSTON DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-8526
Practice Address - Country:US
Practice Address - Phone:269-789-4380
Practice Address - Fax:269-789-4381
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3767207X00000X
MI5101014594207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200Z800130OtherBCBS GROUP
MI200Z800130OtherBCBS GROUP
MI0N82650010Medicare PIN
MI0A37669Medicare PIN