Provider Demographics
NPI:1679541999
Name:KRZYZKOWSKI, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:KRZYZKOWSKI
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 1:5955 RAND BLVD.
Mailing Address - Street 2:TIDEWELL HOSPICE AND PALLIATIVE CARE
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5160
Mailing Address - Country:US
Mailing Address - Phone:941-923-5822
Mailing Address - Fax:941-925-0969
Practice Address - Street 1:5955 RAND BLVD.
Practice Address - Street 2:TIDEWELL HOSPICE AND PALLIATIVE CARE
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5160
Practice Address - Country:US
Practice Address - Phone:941-923-5822
Practice Address - Fax:941-925-0969
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25654OtherUNITED HEATLHCARE
FL301386OtherWELLCARE URGENT CARE
FL214490OtherAMERIGROUP
FL229615OtherAMERIGROUP URGENT CARE
FL311532OtherWELLCARE
FL04690OtherUNIVERSAL
FLP00183786OtherRAILROAD
FL271419100Medicaid
FL01019OtherBCBS
FL311532OtherWELLCARE
FL311532OtherWELLCARE
FLU3997ZMedicare ID - Type UnspecifiedMEDICARE