Provider Demographics
NPI:1659370666
Name:KOLODZIEJ, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:KOLODZIEJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5335
Mailing Address - Country:US
Mailing Address - Phone:616-456-8515
Mailing Address - Fax:616-233-1108
Practice Address - Street 1:350 LAFAYETTE AVE SE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4656
Practice Address - Country:US
Practice Address - Phone:616-456-8515
Practice Address - Fax:616-233-1108
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056334207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4085196Medicaid
M51600009Medicare PIN
MI4085196Medicaid