MEDICARE: DR. NILES PATRICK MUZYK PSYD

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	103TC0700X	Clinical Psychologist	LP2588	KS

General Provider Information

NPI Number	:	1780144089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NILES PATRICK MUZYK PSYD

Provider Business Mailing Address
First Line	:	1531 W 27TH ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-4227
Country	:	US
Telephone Number	:	201-983-7921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SCHWEGLER DR RM 2100
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66045-7558
Country	:	US
Telephone Number	:	785-864-2277
Fax Number	:

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

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	03/22/2019

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