Healthcare Provider Details

I. General information

NPI: 1740731090
Provider Name (Legal Business Name): GRZEGORZ KURZYDLO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19411 MCKAY DR SUITE 200
HUMBLE TX
77338-5713
US

IV. Provider business mailing address

19411 MCKAY DR SUITE 200
HUMBLE TX
77338-5713
US

V. Phone/Fax

Practice location:
  • Phone: 281-570-4112
  • Fax: 281-570-4067
Mailing address:
  • Phone: 281-570-4112
  • Fax: 281-570-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberL7790
License Number StateTX

VIII. Authorized Official

Name: GRZEGORZ P KURZYDLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-570-4112