Healthcare Provider Details

I. General information

NPI: 1447382783
Provider Name (Legal Business Name): MICHAEL STAN KUZLIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 6
JOLIET IL
60434
US

IV. Provider business mailing address

14501 S 88TH AVE
ORLAND PARK IL
60462-2752
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-6256
  • Fax: 815-729-6522
Mailing address:
  • Phone: 708-349-0938
  • Fax: 815-729-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: