Individual
GUY KEDZIORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1915 LAKE AVE, PLYMOUTH, IN 46563-9366
(574) 935-2353
(574) 935-2373
Mailing address
100 E WAYNE ST STE 510, SOUTH BEND, IN 46601-2349
(574) 334-5390
(574) 334-5368
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01039718
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092080
—
IN
05
—
1619977543
—
MI
Enumeration date
07/21/2005
Last updated
01/03/2018
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