Healthcare Provider Details

I. General information

NPI: 1952478281
Provider Name (Legal Business Name): DAVID A PUZYCKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6270 W MAIN ST
EAU CLAIRE MI
49111-9480
US

IV. Provider business mailing address

50 INDUSTRIAL PARK RD
BANGOR MI
49013-1246
US

V. Phone/Fax

Practice location:
  • Phone: 269-461-6927
  • Fax: 269-461-3068
Mailing address:
  • Phone: 269-427-7937
  • Fax: 269-427-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDP065168
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: