Provider Demographics
NPI:1689618449
Name:KUZDAK, RON CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:CHRISTOPHER
Last Name:KUZDAK
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 1:3005 OLD PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-3551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25500 MEADOWBROOK RD STE 260
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1883
Practice Address - Country:US
Practice Address - Phone:248-639-4131
Practice Address - Fax:248-639-3012
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG4727FOtherBLUE CROSS
MI4726371Medicaid
MI140107OtherCARE CHOICES
MI16690OtherMCARE
MI5631196OtherBLUE CROSS
MI4823526Medicaid
MI7019592OtherAETNA
MIP33645FOtherBLUE CROSS
MI140107OtherCARE CHOICES
MI16690OtherMCARE
MIG4727FOtherBLUE CROSS