Provider Demographics
NPI:1790777456
Name:CHROSTOWSKI, AGNIESZKA M (MD)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:M
Last Name:CHROSTOWSKI
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 1:10240 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5904
Mailing Address - Country:US
Mailing Address - Phone:623-385-7900
Mailing Address - Fax:623-792-1233
Practice Address - Street 1:10240 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5904
Practice Address - Country:US
Practice Address - Phone:623-385-7900
Practice Address - Fax:623-792-1233
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR76483Medicare ID - Type Unspecified