Healthcare Provider Details

I. General information

NPI: 1255651394
Provider Name (Legal Business Name): GRZEGORZ KRZYSZTOF BRZEZICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S STE 415
JACKSONVILLE FL
32216-4299
US

IV. Provider business mailing address

3627 UNIVERSITY BLVD S STE 415
JACKSONVILLE FL
32216-4299
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-2522
  • Fax: 904-296-8173
Mailing address:
  • Phone: 904-296-2522
  • Fax: 904-296-8173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME130734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: