Provider Demographics
NPI:1144287095
Name:KOLODZIK-KAYE, TAMARA E (CRNA)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:E
Last Name:KOLODZIK-KAYE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE CHILDREN'S PLAZA
Mailing Address - Street 2:CHILDREN'S ANESTHESIA GROUP, INC.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1815
Mailing Address - Country:US
Mailing Address - Phone:937-641-3350
Mailing Address - Fax:937-641-6145
Practice Address - Street 1:ONE CHILDREN'S PLAZA
Practice Address - Street 2:CHILDREN'S ANESTHESIA GROUP, INC.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1815
Practice Address - Country:US
Practice Address - Phone:937-641-3350
Practice Address - Fax:937-641-6145
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.03206-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0910303Medicaid
OHH213520Medicare UPIN