Provider Demographics
NPI:1750847406
Name:KRYSMALSKI, AUSTIN LOUIS
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:LOUIS
Last Name:KRYSMALSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 S WESTNEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1380
Mailing Address - Country:US
Mailing Address - Phone:248-709-1763
Mailing Address - Fax:
Practice Address - Street 1:1324 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1380
Practice Address - Country:US
Practice Address - Phone:248-709-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program