Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 477025 | WI |
Y | 222Z00000X | Podiatrist | 477025 | WI |
NPI | 1053496067 |
---|---|
Provider Name | Dr. Patrick A Krzyzewski |
First Address | Milwaukee, WI 53207-4410 |
Second Address | Milwaukee, WI 53207-4410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 23/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30016800 | (05) | WI |
AK1051729 | DEA (01) | |
T62501 | (02) |