MEDICARE: DR. MICHAEL BEZOUSKA DO, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	20A7406	CA
2	2083X0100X	Occupational Medicine Physician	20A7406	CA

General Provider Information

NPI Number	:	1710979877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BEZOUSKA DO, MS

Provider Business Mailing Address
First Line	:	PSC 475 BOX 1
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96350-1200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	NMRTU IWAKUNI
Second Line	:	BLDG 110
City	:	FPO
State	:	CA
Zip	:	96310
Country	:	US
Telephone Number	:	315-255-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/04/2025

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