Provider Demographics
NPI:1063449825
Name:KUCY, GEORGE O (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:O
Last Name:KUCY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:O
Other - Last Name:KUCYJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15855 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3504
Mailing Address - Country:US
Mailing Address - Phone:586-263-2458
Mailing Address - Fax:586-263-2258
Practice Address - Street 1:15855 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3504
Practice Address - Country:US
Practice Address - Phone:586-263-2458
Practice Address - Fax:586-263-2258
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI062182207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3193199Medicaid
MI220016Y05OtherRR MCR
MI0F36272008Medicare ID - Type Unspecified
MI3193199Medicaid