Provider Demographics
NPI:1356575625
Name:ANDRZEJ BULCZYNSKI M.D., INC.
Entity type:Organization
Organization Name:ANDRZEJ BULCZYNSKI M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRZEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BULCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-574-0400
Mailing Address - Street 1:13160 MINDANAO WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:310-574-0400
Mailing Address - Fax:310-574-0485
Practice Address - Street 1:13160 MINDANAO WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292
Practice Address - Country:US
Practice Address - Phone:310-574-0400
Practice Address - Fax:310-574-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89040207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty