MEDICARE: BRIAN PRZYSTAWSKI, DPM, PSC

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	213ES0103X	Foot & Ankle Surgery Podiatrist		IN

Other Identifiers

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

General Provider Information

NPI Number	:	1609966159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN PRZYSTAWSKI, DPM, PSC

Provider Business Mailing Address
First Line	:	PO BOX 708
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-0708
Country	:	US
Telephone Number	:	812-945-3916
Fax Number	:	812-944-3404

Provider Business Practice Location Address
First Line	:	2857 CHARLESTOWN RD STE 300
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-0005
Country	:	US
Telephone Number	:	812-948-0211
Fax Number	:	812-948-0880

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN T PRZYSTAWSKI
Credential	:	DPM
Telephone Number	:	812-948-0211

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	11/02/2022

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