Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 5101018249 | MI |
N | 208600000X | Surgeon | 5101018249 | MI |
Y | 208200000X | Surgeon | OS13910 | FL |
Y | 208600000X | Surgeon | OS13910 | FL |
N | 2086S0102X | Surgical Critical Care | OS13910 | FL |
NPI | 1033347265 |
---|---|
Provider Name | Dr. Mark Kuzich |
First Address | Stuart, FL 34995-0417 |
Second Address | Stuart, FL 34994-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018473200 | (05) | FL |
TLFUQ | FLORIDA BLUE (01) | FL |