| Doctor Name: | PETER EARL DAVID KACZKOFSKY |
| NPI Number: | 1710089453 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 012006 |
| Business Practice Address: | 2221 Health Dr Sw Wyoming, MI - 49509 |
| Business Phone Number: | 6165325025 |
| Business Fax Number: | 6165326126 |
| Mailing Address: | 2221 Health Dr Sw, Suite 2100 WYOMING |
| State: | MI |
| Postal Code: | 495199700 |
| Phone Number: | 6165325025 |
| Fax Number: | 6165326126 |
| NPI Enumeration Date: | 09/02/2006 |
| NPI Last Update Date: | 01/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 012006 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |