Provider Demographics
NPI:1598746109
Name:CYTRYNOWICZ, KARL (DO)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:CYTRYNOWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 NORTH WABASH AVENUE
Mailing Address - Street 2:SUITE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7600
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:330 N WABASH AVE STE 430
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2686
Practice Address - Country:US
Practice Address - Phone:765-660-7630
Practice Address - Fax:765-671-3501
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002300A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200444710AMedicaid
IN000000292442OtherANTHEM BCBS
IN000000292442OtherANTHEM BCBS
IN200444710AMedicaid