Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 4301056334 | MI |
NPI | 1659370666 |
---|---|
Provider Name | Dr. Patricia Kolodziej |
First Address | Chicago, IL 60689-5335 |
Second Address | Grand Rapids, MI 49503-4656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 21/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4085196 | (05) | MI |
G37013 | (02) |