Healthcare Provider Details

I. General information

NPI: 1558335299
Provider Name (Legal Business Name): KURT RUDIGER PIATKOWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KURT RUDIGER PIATKOWSKI D.O.

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WINSTON DR
MARSHALL MI
49068-8526
US

IV. Provider business mailing address

176 DAWKINS DR
LEWISBURG WV
24901-9302
US

V. Phone/Fax

Practice location:
  • Phone: 269-789-4380
  • Fax: 269-789-4381
Mailing address:
  • Phone: 304-645-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3767
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101014594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: