Provider Demographics
NPI:1598896268
Name:KWIATKOWSKI, SCOTT W (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:KWIATKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1788 IVYCREST WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1203
Mailing Address - Country:US
Mailing Address - Phone:240-271-4086
Mailing Address - Fax:
Practice Address - Street 1:1788 IVYCREST WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1203
Practice Address - Country:US
Practice Address - Phone:240-271-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83059207Q00000X
TXS2095207Q00000X
OH34.014374207Q00000X, 207Q00000X
ARE-12038207Q00000X
TN3657207Q00000X
CA20A11602207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine