Provider Demographics
NPI:1447251905
Name:GODLEWSKI, BOGUSLAW (MD)
Entity type:Individual
Prefix:DR
First Name:BOGUSLAW
Middle Name:
Last Name:GODLEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AUSTIN HEART PLLC
Mailing Address - Street 2:PO BOX 402669
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2669
Mailing Address - Country:US
Mailing Address - Phone:512-206-4300
Mailing Address - Fax:512-206-4350
Practice Address - Street 1:1330 WONDER WORLD DR
Practice Address - Street 2:STE B108
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7566
Practice Address - Country:US
Practice Address - Phone:512-396-5603
Practice Address - Fax:512-396-5623
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4848207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1025405-03Medicaid
TX1025405-03Medicaid
TX8827M0Medicare PIN