Provider Demographics
NPI:1396916532
Name:KACZMARSKI, MATTHEW JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JACOB
Last Name:KACZMARSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M. JACOB
Other - Middle Name:
Other - Last Name:KACZMARSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6875 SW 69TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3136
Mailing Address - Country:US
Mailing Address - Phone:317-514-4881
Mailing Address - Fax:
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:786-596-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103293207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology