Provider Demographics
NPI:1124052105
Name:DURAKIEWICZ, MAREK (MD)
Entity type:Individual
Prefix:DR
First Name:MAREK
Middle Name:
Last Name:DURAKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E SWAN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1417
Mailing Address - Country:US
Mailing Address - Phone:931-729-4271
Mailing Address - Fax:931-729-6793
Practice Address - Street 1:135 E SWAN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1417
Practice Address - Country:US
Practice Address - Phone:931-729-4271
Practice Address - Fax:931-729-6793
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031508207P00000X
TN31508207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3847187Medicare PIN