Basic Information
| Provider Information | |||||||||
| NPI: | 1053318923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KACZMARSKA | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 880 COLLOREDO BLVD | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316858111 | ||||||||
| FaxNumber: | 9316801050 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 COLLOREDO BLVD | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316858111 | ||||||||
| FaxNumber: | 9316801050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 09/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | MD28127 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3803699 | 05 | TN | MEDICAID |