Provider Demographics
NPI:1598847758
Name:STEGAWSKI, KRZYSZTOF CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:CHRISTOPHER
Last Name:STEGAWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:STEGAWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:28515 E BROCKWAY DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5245
Mailing Address - Country:US
Mailing Address - Phone:440-781-6240
Mailing Address - Fax:
Practice Address - Street 1:28515 E BROCKWAY DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5245
Practice Address - Country:US
Practice Address - Phone:440-781-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044751261Q00000X
IN29743207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0482722Medicaid
ST0548622Medicare ID - Type Unspecified
OHC02748Medicare UPIN