Healthcare Provider Details

I. General information

NPI: 1962612820
Provider Name (Legal Business Name): CHIKA KUZUMI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

80 E HANCOCK ST APT 1501
DETROIT MI
48201-1337
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-7233
  • Fax:
Mailing address:
  • Phone: 313-831-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301083914
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301083914
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: