Healthcare Provider Details

I. General information

NPI: 1477824852
Provider Name (Legal Business Name): JOSEPH FRANCIS KUSIAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 SHADY BEND
FORT MYERS FL
33905
US

IV. Provider business mailing address

3320 SHADY BEND
FORT MYERS FL
33905
US

V. Phone/Fax

Practice location:
  • Phone: 239-693-1655
  • Fax: 239-693-1656
Mailing address:
  • Phone: 239-693-1655
  • Fax: 239-693-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME 92208
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD018362E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: