Individual
MATTHEW PAUL KICZEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287
(410) 955-5000
Mailing address
9910 FRANKLIN SQUARE DR # 2110, BALTIMORE, MD 21236-4902
(410) 933-6421
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
H87203
MD
2085R0202X
Diagnostic Radiology Physician
Primary
H87203
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H87203
LICENSE
MD
Enumeration date
03/18/2013
Last updated
07/24/2019
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