Healthcare Provider Details

I. General information

NPI: 1033598248
Provider Name (Legal Business Name): STEVEN D KOZUSKO MD, MED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST STE 330
BANGOR ME
04401-6638
US

IV. Provider business mailing address

43 WHITING HILL RD STE 330
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8881
  • Fax: 207-973-8880
Mailing address:
  • Phone: 207-973-5035
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMD28122
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD28122
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: