Provider Demographics
NPI:1659512549
Name:DR. KATHLEEN DUZAK DPM PC
Entity Type:Organization
Organization Name:DR. KATHLEEN DUZAK DPM PC
Other - Org Name:DUZAK FAMILY FOOT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-421-7400
Mailing Address - Street 1:1770 WOODGROVE LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2673
Mailing Address - Country:US
Mailing Address - Phone:734-421-7400
Mailing Address - Fax:
Practice Address - Street 1:1770 WOODGROVE LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2673
Practice Address - Country:US
Practice Address - Phone:734-421-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858250820OtherBLUE CROSS BLUE SHIELD
MI2122782Medicaid
MI4858250820OtherBCBS