Provider Demographics
NPI:1831445279
Name:KACZMAREK, BARTOSZ FILIP (MD)
Entity type:Individual
Prefix:DR
First Name:BARTOSZ
Middle Name:FILIP
Last Name:KACZMAREK
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 1:5635 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-3154
Mailing Address - Country:US
Mailing Address - Phone:313-849-3920
Mailing Address - Fax:
Practice Address - Street 1:5635 W FORT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209
Practice Address - Country:US
Practice Address - Phone:313-586-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine