Healthcare Provider Details

I. General information

NPI: 1689618449
Provider Name (Legal Business Name): RON CHRISTOPHER KUZDAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEADOWBROOK RD STE 260
NOVI MI
48375-1883
US

IV. Provider business mailing address

3005 OLD PLANK RD
MILFORD MI
48381-3551
US

V. Phone/Fax

Practice location:
  • Phone: 248-639-4131
  • Fax: 248-639-3012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: