Provider Demographics
NPI:1134239387
Name:OSZCZAKIEWICZ, MICHAEL T (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:OSZCZAKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 COLLEGE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4688
Mailing Address - Country:US
Mailing Address - Phone:409-212-6280
Mailing Address - Fax:409-212-6286
Practice Address - Street 1:3070 COLLEGE ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4688
Practice Address - Country:US
Practice Address - Phone:409-212-6280
Practice Address - Fax:092-126-2864
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5455208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX780001170Medicaid
89712FMedicare ID - Type Unspecified
E52448Medicare UPIN