Provider Demographics
NPI:1184316333
Name:HABDANK-KOLACZKOWSKI, JULIAN STEFAN (MD, AP)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:STEFAN
Last Name:HABDANK-KOLACZKOWSKI
Suffix:
Gender:M
Credentials:MD, AP
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Mailing Address - Street 1:1121 JOHNSON ROAD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:770-694-6349
Mailing Address - Fax:
Practice Address - Street 1:400 CHESTERFIELD CTR STE 500
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4891
Practice Address - Country:US
Practice Address - Phone:636-489-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022047511363A00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant