Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME92625 | FL |
N | 208000000X | Pediatrician | ME92625 | FL |
NPI | 1164491866 |
---|---|
Provider Name | Dr. Katarzyna I. Madejczyk |
First Address | Daytona Beach, FL 32114-2709 |
Second Address | Daytona Beach, FL 32114-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 27/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278501300 | (05) | FL |
H50738 | (02) | FL |