Healthcare Provider Details

I. General information

NPI: 1023018546
Provider Name (Legal Business Name): EDWARD J KROWIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188A NORTH MERIDIAN ST SUITE 375
CARMEL IN
46032-4578
US

IV. Provider business mailing address

12188A NORTH MERIDIAN ST SUITE 375
CARMEL IN
46032-4578
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-1056
  • Fax: 317-579-0476
Mailing address:
  • Phone: 317-926-1056
  • Fax: 317-579-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01056660
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: