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NPI Code Detail

MEDICARE: DR. CHRISTINA A BORYCZKA MD

MEDICARE: DR. CHRISTINA A BORYCZKA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician70122WI
2207Q00000XFamily Medicine Physician44514MN
3207R00000XInternal Medicine Physician44514MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053398255
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTINA A BORYCZKA MD
Provider Business Mailing Address
First Line : 2004 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1931
Country : US
Telephone Number : 612-457-0216
Fax Number : 612-457-0216
Provider Business Practice Location Address
First Line : 5200 DOUGLAS DR N
Second Line :
City : CRYSTAL
State : MN
Zip : 55429-3104
Country : US
Telephone Number : 763-400-3628
Fax Number : 763-342-4183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 09/14/2023

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