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General NPI Number Information
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NPI Number | 1013218510
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Entity Type | Organization
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Legal Business Name | STEFAN A KIEDROWSKI, MD, PA
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 1879 PROFESSIONAL PARK CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4506
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Country | US
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Telephone | 850-878-1044
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Fax | 850-656-7504
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Provider Business Mailing Address
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Address Line | 1879 PROFESSIONAL PARK CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4506
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Country | US
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Telephone | 850-878-1044
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Fax | 850-656-7504
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Authorized Official
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Title or Position | M.D./OWNER
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Name | DR. STEFAN KIEDROWSKI
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Credential | M.D.
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Telephone | 850-878-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME40345
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License Number State | FL
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