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NPI Code Detail

MEDICARE: MR. MICHAEL KEVIN KOLODZIEJ MFT

MEDICARE:  MR. MICHAEL KEVIN KOLODZIEJ  MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 43472CA

General Provider Information

NPI Number : 1285700336
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL KEVIN KOLODZIEJ MFT
Provider Business Mailing Address
First Line : 5650 MOUNT ACKERLY DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-4016
Country : US
Telephone Number : 858-302-3300
Fax Number : 858-292-9529
Provider Business Practice Location Address
First Line : 5650 MOUNT ACKERLY DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-4016
Country : US
Telephone Number : 858-302-3300
Fax Number : 858-292-9529
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 09/12/2019

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Directions to “ MR. MICHAEL KEVIN KOLODZIEJ MFT” Practice Location

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