Provider Demographics
NPI:1245450832
Name:BIGOSINSKI, KRYSTIAN W (MD)
Entity type:Individual
Prefix:DR
First Name:KRYSTIAN
Middle Name:W
Last Name:BIGOSINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301C US ROUTE ONE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:100 BRICKHILL AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-773-0040
Practice Address - Fax:207-824-4900
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121017207QS0010X
MEMD20416207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121017OtherIL STATE MEDICAL LICENSE
WAML20008426OtherSTATE MEDICAL LISCENCE
IL20706713 (207067)Medicare UPIN
WAML20008426OtherSTATE MEDICAL LISCENCE