Provider Demographics
NPI:1457300212
Name:KAUZLARICH, JOHN W (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KAUZLARICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:727-397-3853
Mailing Address - Fax:
Practice Address - Street 1:2810 W MLK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-877-8450
Practice Address - Fax:813-877-6513
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS03478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27337Medicare UPIN
FL81921UMedicare ID - Type Unspecified