Healthcare Provider Details

I. General information

NPI: 1053318923
Provider Name (Legal Business Name): BARBARA F KACZMARSKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 COLLOREDO BLVD
SHELBYVILLE TN
37160-2774
US

IV. Provider business mailing address

880 COLLOREDO BLVD
SHELBYVILLE TN
37160-2774
US

V. Phone/Fax

Practice location:
  • Phone: 931-685-8111
  • Fax: 931-680-1050
Mailing address:
  • Phone: 931-685-8111
  • Fax: 931-680-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD28127
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: