Healthcare Provider Details

I. General information

NPI: 1699909549
Provider Name (Legal Business Name): ADAM M KUZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34020 7 MILE RD STE 101
LIVONIA MI
48152-3093
US

IV. Provider business mailing address

1038 LONGSPUR BLVD
LAKE ORION MI
48360-2561
US

V. Phone/Fax

Practice location:
  • Phone: 248-516-5016
  • Fax: 833-969-3912
Mailing address:
  • Phone: 248-765-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704245162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: