Healthcare Provider Details

I. General information

NPI: 1114402468
Provider Name (Legal Business Name): ANNE MARIE KUZMA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 W BIG BEAVER RD
TROY MI
48084-3510
US

IV. Provider business mailing address

18910 WARWICK ST
BEVERLY HILLS MI
48025-4070
US

V. Phone/Fax

Practice location:
  • Phone: 248-458-0400
  • Fax:
Mailing address:
  • Phone: 248-379-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704284258
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: