Provider Demographics
NPI:1376732818
Name:KACZYNSKI, RAFAL PIOTR (MD)
Entity type:Individual
Prefix:
First Name:RAFAL
Middle Name:PIOTR
Last Name:KACZYNSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:
Other - Last Name:KACZYNSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6350 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1430
Mailing Address - Country:US
Mailing Address - Phone:727-381-1144
Mailing Address - Fax:727-381-6901
Practice Address - Street 1:6350 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1430
Practice Address - Country:US
Practice Address - Phone:727-381-1144
Practice Address - Fax:727-381-6901
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine