Healthcare Provider Details

I. General information

NPI: 1912981234
Provider Name (Legal Business Name): BARBARA M KUCZYNSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 14 MILE RD STE B
CLAWSON MI
48017
US

IV. Provider business mailing address

30150 TELEGRAPH RD STE 271
BINGHAM FARMS MI
48025-4521
US

V. Phone/Fax

Practice location:
  • Phone: 248-589-9500
  • Fax: 248-589-9587
Mailing address:
  • Phone: 248-395-5175
  • Fax: 734-743-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301063340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: