Provider Demographics
NPI:1427448547
Name:KWIATKOWSKI MD PLLC
Entity type:Organization
Organization Name:KWIATKOWSKI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNG MBR
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KWIATKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-617-9599
Mailing Address - Street 1:PO BOX 530521
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0521
Mailing Address - Country:US
Mailing Address - Phone:702-617-9599
Mailing Address - Fax:702-614-0059
Practice Address - Street 1:10410 S EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4196
Practice Address - Country:US
Practice Address - Phone:702-617-9599
Practice Address - Fax:702-614-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty