Provider Demographics
NPI:1861455339
Name:KURCZYNSKI, ELIZABETH MICKELSEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MICKELSEN
Last Name:KURCZYNSKI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3302
Mailing Address - Country:US
Mailing Address - Phone:304-388-1559
Mailing Address - Fax:304-388-1577
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3302
Practice Address - Country:US
Practice Address - Phone:304-388-1559
Practice Address - Fax:304-388-1577
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV188742080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0079807000Medicaid
WV0079807000Medicaid
D29999Medicare UPIN