Healthcare Provider Details

I. General information

NPI: 1346253457
Provider Name (Legal Business Name): ROBERT W KYRCZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FLAT ROCK PL
WESTBROOK CT
06498-3586
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3640
  • Fax: 860-358-8656
Mailing address:
  • Phone: 860-358-6000
  • Fax: 860-284-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number027543
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: