Provider Demographics
NPI:1447382783
Name:KUZLIK, MICHAEL STAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STAN
Last Name:KUZLIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 S 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2752
Mailing Address - Country:US
Mailing Address - Phone:708-349-0938
Mailing Address - Fax:815-729-6522
Practice Address - Street 1:RT 6
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60434
Practice Address - Country:US
Practice Address - Phone:815-729-6256
Practice Address - Fax:815-729-6522
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine