Healthcare Provider Details

I. General information

NPI: 1437964533
Provider Name (Legal Business Name): ANGELA KUDZIA LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 W BIG BEAVER RD
TROY MI
48084-5220
US

IV. Provider business mailing address

15442 ROXBURY CIR
MACOMB MI
48044-3866
US

V. Phone/Fax

Practice location:
  • Phone: 586-855-2683
  • Fax:
Mailing address:
  • Phone: 586-855-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361002402
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: