Basic Information
Provider Information
NPI: 1275896490
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARCZEWSKI
FirstName: WILLIAM
MiddleName: DAVID
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 30516
Address2: DEPT. 9516
City: LANSING
State: MI
PostalCode: 48909
CountryCode: US
TelephoneNumber: 2319350497
FaxNumber: 2319350498
Practice Location
Address1: 1105 SIXTH ST
Address2:  
City: TRAVERSE CITY
State: MI
PostalCode: 496842345
CountryCode: US
TelephoneNumber: 2319350497
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/21/2012
LastUpdateDate: 04/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X4301100753MIY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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