Healthcare Provider Details

I. General information

NPI: 1558724955
Provider Name (Legal Business Name): DANIEL RYCZEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 7TH AVE N
SAINT PETERSBURG FL
33705
US

IV. Provider business mailing address

7007 129TH ST N
SEMINOLE FL
33776-4327
US

V. Phone/Fax

Practice location:
  • Phone: 727-825-1100
  • Fax:
Mailing address:
  • Phone: 727-365-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME139380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: