Healthcare Provider Details

I. General information

NPI: 1124391248
Provider Name (Legal Business Name): BRETT MICHAEL KUSMIT RPA/RA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16641 N. 40TH ST., STE 1
PHOENIX AZ
85032-3343
US

IV. Provider business mailing address

2323 W. ROSE GARDEN LANE
PHOENIX AZ
85027-2530
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-7999
  • Fax: 623-842-5640
Mailing address:
  • Phone: 623-931-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: