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General NPI Number Information
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NPI Number | 1003878109
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Entity Type | Individual
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Provider Name | DEBORA ANN KACZYNSKI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 18181 OAKWOOD BLVD
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City | DEARBORN
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State | MI
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Zip | 48124-5032
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Country | US
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Telephone | 313-593-1573
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 WATERWAYS DR
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City | ANN ARBOR
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State | MI
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Zip | 48108-2783
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Country | US
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Telephone | 734-913-8595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301061553
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License Number State | MI
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