Healthcare Provider Details

I. General information

NPI: 1013965540
Provider Name (Legal Business Name): MICHAEL HILTON KUZMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-0589
US

IV. Provider business mailing address

PO BOX 8003
MORGANTOWN WV
26506-8003
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4478
  • Fax:
Mailing address:
  • Phone: 304-598-4478
  • Fax: 304-598-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA002064
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2006
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: