Provider Demographics
NPI:1740309418
Name:KAMIEN, PRZEMYSLAW MATEUSZ (MD)
Entity type:Individual
Prefix:
First Name:PRZEMYSLAW
Middle Name:MATEUSZ
Last Name:KAMIEN
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 1:1626 TUTTLE ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1501
Mailing Address - Country:US
Mailing Address - Phone:608-355-6868
Mailing Address - Fax:608-356-6787
Practice Address - Street 1:1626 TUTTLE ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1501
Practice Address - Country:US
Practice Address - Phone:608-355-6868
Practice Address - Fax:608-356-6787
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49765207X00000X
WI72723-20207X00000X
IL036130340207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201114620Medicaid
WI1740309418Medicaid
MN542125000Medicaid
IAENROLLEDMedicaid
IL036.120340OtherSTATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATIONS.
IN000000791353OtherANTHEM BCBS
WI35273100Medicaid