Healthcare Provider Details

I. General information

NPI: 1396078754
Provider Name (Legal Business Name): JOHN HERBERT KUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 PARRIS ISLAND PL
THE VILLAGES FL
32162
US

IV. Provider business mailing address

2165 PARRIS ISLAND PL
THE VILLAGES FL
32162
US

V. Phone/Fax

Practice location:
  • Phone: 352-446-2981
  • Fax: 352-446-2981
Mailing address:
  • Phone: 352-446-2981
  • Fax: 352-446-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME 104313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: