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General NPI Number Information
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NPI Number | 1174098214
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Entity Type | Individual
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Provider Name | MICHAEL A KRZYSKOWSKI
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Gender | Male
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 9900 COLUMBIA AVE
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City | MUNSTER
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State | IN
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Zip | 46321-4008
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Country | US
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Telephone | 121-992-4330
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Fax | 219-934-2658
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Provider Business Mailing Address
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Address Line | 730 45TH ST
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City | MUNSTER
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State | IN
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Zip | 46321-2818
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Country | US
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Telephone | 121-992-4330
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Fax | 219-934-2658
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 100026494A
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License Number State | IN
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