Organization Name: | DPMKRYWIAKPROH LLC |
NPI Number: | 1083971659 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ADRIANA R KRYWIAK (SOLE MEMBER) |
Mailing Address: | 5500 Ridge Rd 138 Parma |
State: | OH US |
Postal Code: | 441292394 |
Phone Number: | 4408841034 |
Fax Number: | 4408840755 |
NPI Enumeration Date: | 04/19/2012 |
NPI Last Update Date: | 04/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 36.003526 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |