Healthcare Provider Details

I. General information

NPI: 1346401528
Provider Name (Legal Business Name): NADIA BOULGHASSOUL-PIETRZYKOWSKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 E WOODLAND AVE
BARRON WI
54812-1765
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

V. Phone/Fax

Practice location:
  • Phone: 715-537-3166
  • Fax:
Mailing address:
  • Phone: 715-838-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number25MA08970300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08970300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMC-261
License Number StateGU
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20828
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: