MEDICARE: EDYTA KRZAK MULARCZYK MD

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
1	207R00000X	Internal Medicine Physician	ME108778	FL
2	207R00000X	Internal Medicine Physician	233599	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33803A	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1629080023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDYTA KRZAK MULARCZYK MD

Provider Business Mailing Address
First Line	:	1001 NW 13TH ST STE 201
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-2269
Country	:	US
Telephone Number	:	561-955-6663
Fax Number	:	561-955-2879

Provider Business Practice Location Address
First Line	:	8200 S JOG RD
Second Line	:	STE 102
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2981
Country	:	US
Telephone Number	:	561-733-3970
Fax Number	:	561-733-3690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	06/06/2022

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