Provider Demographics
NPI:1427067651
Name:KOCZOROWSKA, STANISLAWA KRYSTYNA (MD)
Entity type:Individual
Prefix:
First Name:STANISLAWA
Middle Name:KRYSTYNA
Last Name:KOCZOROWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:K
Other - Last Name:KOCZOROWSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-0727
Mailing Address - Country:US
Mailing Address - Phone:260-343-0797
Mailing Address - Fax:260-343-0799
Practice Address - Street 1:727 E NORTH ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1225
Practice Address - Country:US
Practice Address - Phone:260-343-0797
Practice Address - Fax:260-343-0799
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7275OtherPHP
000000093825OtherBLUE SHIELD
87726OtherUNITED HEALTH CARE
7275OtherPHP
IN147210Medicare ID - Type Unspecified