MEDICARE: DR. ROBERT B GRZYWACZ DPM

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
1	213E00000X	Podiatrist	793965375	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00058662	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5623276299	OTHER	NV	TIN

General Provider Information

NPI Number	:	1316148646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT B GRZYWACZ DPM

Provider Business Mailing Address
First Line	:	3221 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-733-7617
Fax Number	:	702-733-1732

Provider Business Practice Location Address
First Line	:	3221 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-733-7617
Fax Number	:	702-733-1732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	05/23/2008

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