Healthcare Provider Details

I. General information

NPI: 1952593279
Provider Name (Legal Business Name): MARK KAZEWHYCH, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N MACARTHUR BLVD SUITE 100
IRVING TX
75061-2225
US

IV. Provider business mailing address

2120 N MACARTHUR BLVD SUITE 100
IRVING TX
75061-2225
US

V. Phone/Fax

Practice location:
  • Phone: 972-438-4636
  • Fax: 214-260-0953
Mailing address:
  • Phone: 972-438-4636
  • Fax: 214-260-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberL5404
License Number StateTX

VIII. Authorized Official

Name: MARK A KAZEWHYCH
Title or Position: PHYSICIAN
Credential: MD
Phone: 972-438-4636