Healthcare Provider Details

I. General information

NPI: 1457540783
Provider Name (Legal Business Name): GEORGE H KUZMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 12TH ST N
WHEATON MN
56296-1070
US

IV. Provider business mailing address

401 12TH ST N
WHEATON MN
56296-1070
US

V. Phone/Fax

Practice location:
  • Phone: 320-563-8226
  • Fax: 320-563-0212
Mailing address:
  • Phone: 320-563-8226
  • Fax: 320-563-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number103817
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: