Provider Demographics
NPI:1659353753
Name:KWIATKOWSKI, TERRANCE J (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:J
Last Name:KWIATKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530521
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0521
Mailing Address - Country:US
Mailing Address - Phone:702-966-3100
Mailing Address - Fax:702-966-9909
Practice Address - Street 1:8530 W SUNSET RD STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-966-3100
Practice Address - Fax:702-966-9909
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9962207YX0901X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ843731Medicaid
AZZ79812Medicare PIN
AZ843731Medicaid
P00139431Medicare PIN
P00139431Medicare PIN
H31538Medicare UPIN
AZZ124670Medicare PIN