Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | OS10488 | FL |
N | 208600000X | Surgeon | OS10488 | FL |
Y | 2086S0102X | Surgical Critical Care | OS10488 | FL |
NPI | 1194975334 |
---|---|
Provider Name | Michael F Ksycki |
First Address | Miami, FL 33136-1005 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 11/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005551-00 | (05) | FL |