Provider Demographics
NPI:1972795102
Name:KRAKOWIAK- COLASACCO, IZABELA (DO)
Entity type:Individual
Prefix:DR
First Name:IZABELA
Middle Name:
Last Name:KRAKOWIAK- COLASACCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:IZABELA
Other - Middle Name:OLGA
Other - Last Name:KRAKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:701 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2961
Mailing Address - Country:US
Mailing Address - Phone:860-741-6058
Mailing Address - Fax:413-733-5860
Practice Address - Street 1:701 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2961
Practice Address - Country:US
Practice Address - Phone:860-741-6058
Practice Address - Fax:413-733-5860
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046632207R00000X
MA254091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095363/AMedicaid
MA110095363/AMedicaid