Provider Demographics
NPI:1558468249
Name:BR KRYGOWSKI MD INC
Entity Type:Organization
Organization Name:BR KRYGOWSKI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRYGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-344-1513
Mailing Address - Street 1:1840 POST RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2832
Mailing Address - Country:US
Mailing Address - Phone:715-344-1513
Mailing Address - Fax:715-344-2261
Practice Address - Street 1:1840 POST RD
Practice Address - Street 2:SUITE 7
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-2832
Practice Address - Country:US
Practice Address - Phone:715-344-1513
Practice Address - Fax:715-344-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21353020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21353020OtherLICENSE
WI21353020OtherLICENSE