Individual
DR. KENNETH E KRZYZANIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
823 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 449-1010
(843) 497-6171
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD10499
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104997
—
SC
01
—
340011957
RAILROAD MEDICARE
SC
01
—
771701
WELLCARE
SC
01
—
80023039
SELECT HEALTH
SC
05
—
890508M
—
NC
05
—
GP1418
—
SC
05
—
GP454522
—
SC
01
—
P00360560
RAILROAD MEDICARE
SC
Enumeration date
11/04/2005
Last updated
12/29/2016
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