Provider Demographics
NPI:1982669065
Name:DZIURZYNSKI, KRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:DZIURZYNSKI
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:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-0690
Mailing Address - Country:US
Mailing Address - Phone:330-363-7444
Mailing Address - Fax:330-363-7770
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 520
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4699
Practice Address - Country:US
Practice Address - Phone:330-454-0702
Practice Address - Fax:330-454-0708
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449755207T00000X
OH35.149150207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102855050Medicaid
PA301699FX1Medicare PIN