Healthcare Provider Details

I. General information

NPI: 1497259212
Provider Name (Legal Business Name): MICHAL PLOCIENNICZAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

830 HARRISON AVE FL 1
BOSTON MA
02118-2905
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-1444
  • Fax:
Mailing address:
  • Phone: 617-638-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number275625
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: