Provider Demographics
NPI:1992783393
Name:KRZEMINSKI, STEPHEN GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GEORGE
Last Name:KRZEMINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 PALUXY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5641
Mailing Address - Country:US
Mailing Address - Phone:817-573-6673
Mailing Address - Fax:817-573-9783
Practice Address - Street 1:1305 PALUXY RD
Practice Address - Street 2:SUITE A
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5641
Practice Address - Country:US
Practice Address - Phone:817-573-6673
Practice Address - Fax:817-573-9783
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8272207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C6109Medicare ID - Type Unspecified
TXG90581Medicare UPIN