Provider Demographics
NPI:1073807905
Name:DR. JOHN W KAUZLARICH
Entity Type:Organization
Organization Name:DR. JOHN W KAUZLARICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KAUZLARICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-460-1300
Mailing Address - Street 1:9110 CYPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1152
Mailing Address - Country:US
Mailing Address - Phone:727-460-1300
Mailing Address - Fax:727-393-4447
Practice Address - Street 1:9110 CYPRESS TRL
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1152
Practice Address - Country:US
Practice Address - Phone:727-460-1300
Practice Address - Fax:727-393-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS03478261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001036700Medicaid
FL001036700Medicaid