Provider Demographics
NPI:1669561312
Name:SOBIERAJ, KRZYSZTOF MACIEJ (MD)
Entity type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:MACIEJ
Last Name:SOBIERAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-9635
Mailing Address - Country:US
Mailing Address - Phone:304-489-1440
Mailing Address - Fax:304-420-7162
Practice Address - Street 1:214 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-9635
Practice Address - Country:US
Practice Address - Phone:304-489-1440
Practice Address - Fax:304-420-7162
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0079254000Medicaid
WVS00815675Medicare ID - Type Unspecified
G41587Medicare UPIN