Healthcare Provider Details

I. General information

NPI: 1407159692
Provider Name (Legal Business Name): PATRICK A. KRZYZEWSKI, D.P.M.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7635 W OKLAHOMA AVE SUITE 110
MILWAUKEE WI
53219-3600
US

IV. Provider business mailing address

7635 W OKLAHOMA AVE SUITE 110
MILWAUKEE WI
53219-3600
US

V. Phone/Fax

Practice location:
  • Phone: 414-546-3100
  • Fax: 414-546-1881
Mailing address:
  • Phone: 414-546-3100
  • Fax: 414-546-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number477-25
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number477-25
License Number StateWI

VIII. Authorized Official

Name: DR. PATRICK ALBERT KRZYZEWSKI
Title or Position: CEO
Credential: D.P.M.
Phone: 414-546-3100