Provider Demographics
NPI:1740389212
Name:KOSTRZEWSKI, JAMES MICHAEL (R, MR)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:KOSTRZEWSKI
Suffix:
Gender:M
Credentials:R, MR
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1361 WEKIVA WAY
Mailing Address - Street 2:
Mailing Address - City:ST . AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092
Mailing Address - Country:US
Mailing Address - Phone:904-491-7700
Mailing Address - Fax:
Practice Address - Street 1:1699 S 14TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1963
Practice Address - Country:US
Practice Address - Phone:904-491-7701
Practice Address - Fax:904-491-7701
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCRT71643247100000X
2626372471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging