Provider Demographics
NPI:1366530784
Name:KUSMIREK, SLAWOMIR (MD)
Entity type:Individual
Prefix:
First Name:SLAWOMIR
Middle Name:
Last Name:KUSMIREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SLAWOMIR
Other - Middle Name:LUKE
Other - Last Name:KUSMIREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:245 N 15TH ST # MS 470
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-3457
Practice Address - Fax:215-762-3028
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431778207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease