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NPI Code Detail

MEDICARE: MRS. MICHELLE KUJAWA PT

MEDICARE: MRS. MICHELLE KUJAWA PT
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
1225100000XPhysical Therapist11-03291KS
22251X0800XOrthopedic Physical Therapist
3225100000XPhysical Therapist070.015449IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00751927OTHERILMEDICARE RAILROAD GRP PTAN

General Provider Information

NPI Number : 1932103348
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE KUJAWA PT
Provider Business Mailing Address
First Line : 2810 FRANK SCOTT PKWY W
Second Line : SUITE 824
City : BELLEVILLE
State : IL
Zip : 62223-5007
Country : US
Telephone Number : 618-234-9705
Fax Number : 618-257-0665
Provider Business Practice Location Address
First Line : 211 E HANOVER ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1811
Country : US
Telephone Number : 618-588-4000
Fax Number : 618-588-4800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 11/06/2009

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Directions to “ MRS. MICHELLE KUJAWA PT” Practice Location

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