Healthcare Provider Details

I. General information

NPI: 1427219633
Provider Name (Legal Business Name): MALGORZATA ANNA ZUKOWSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEACEHEALTH HOSPITAL MEDICINE 3377 RIVERBEND DRIVE
SPRINGFIELD OR
97477-8803
US

IV. Provider business mailing address

PEACEHEALTH HOSPITAL MEDICINE 3377 RIVERBEND DRIVE
SPRINGFIELD OR
97477-8803
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6389
  • Fax: 541-222-6385
Mailing address:
  • Phone: 541-222-6389
  • Fax: 541-222-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2011016787
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD162713
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: