Individual
PETER EARL DAVID KACZKOFSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2221 HEALTH DR SW, WYOMING, MI 49509
(616) 252-4410
(616) 252-4480
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9700
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
012006
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1654101584
BLUE CARE NETWORD
MI
05
—
4708005
—
MI
05
—
4708168
—
MI
05
—
4708195
—
MI
05
—
4708275
—
MI
Enumeration date
09/02/2006
Last updated
12/08/2017
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