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General NPI Number Information
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NPI Number | 1508807553
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Entity Type | Individual
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Provider Name | MACIEJ KUSMIERCZYK PT
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18241 MCNICHOLS
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City | DETROIT
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State | MI
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Zip | 48219
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Country | US
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Telephone | 313-537-4235
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Fax | 313-537-4213
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Provider Business Mailing Address
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Address Line | 30200 SCHOENHERR RD STE C
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-459-1614
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Fax | 586-775-2331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501005466
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License Number State | MI
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