Provider Demographics
NPI:1982746608
Name:KACZMARCZYK, MARZENA (PA)
Entity type:Individual
Prefix:
First Name:MARZENA
Middle Name:
Last Name:KACZMARCZYK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 HIGHLAND CROSS DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1733
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:
Practice Address - Street 1:13111 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5803
Practice Address - Country:US
Practice Address - Phone:281-784-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001524A363A00000X
TXPA04589363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9808OtherBCBS
TX196291201Medicaid
TX196291202Medicaid
TX8Y8214OtherBCBSTX
TX1982746608OtherTRICARE SOUTH
TX8K8573Medicare PIN
TXP00650485Medicare PIN
TX1982746608OtherTRICARE SOUTH
TX8Y8214OtherBCBSTX
TX8J5973Medicare PIN