MEDICARE: MR. WILLIAM J KUZBYT 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	103T00000X	Psychologist	PY6646	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73060	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982697199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM J KUZBYT PSYD

Provider Business Mailing Address
First Line	:	4061 BONITA BEACH RD
Second Line	:	STE 105
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4073
Country	:	US
Telephone Number	:	352-793-5900
Fax Number	:	352-793-8050

Provider Business Practice Location Address
First Line	:	4061 BONITA BEACH RD
Second Line	:	STE 105
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4073
Country	:	US
Telephone Number	:	239-221-3399
Fax Number	:	239-300-2759

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	05/23/2018

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