Healthcare Provider Details

I. General information

NPI: 1609966159
Provider Name (Legal Business Name): BRIAN PRZYSTAWSKI, DPM, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2857 CHARLESTOWN RD STE 300
NEW ALBANY IN
47150-0005
US

IV. Provider business mailing address

PO BOX 708
PROSPECT KY
40059-0708
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-0211
  • Fax: 812-948-0880
Mailing address:
  • Phone: 812-945-3916
  • Fax: 812-944-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. BRIAN T PRZYSTAWSKI
Title or Position: OWNER
Credential: DPM
Phone: 812-948-0211