Provider Demographics
NPI:1689625469
Name:KUJACZNSKI, STEVE (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:KUJACZNSKI
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 1:261 M 62
Mailing Address - Street 2:
Mailing Address - City:CASSOPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49031-1034
Mailing Address - Country:US
Mailing Address - Phone:269-445-3874
Mailing Address - Fax:269-445-2076
Practice Address - Street 1:261 M 62
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-1034
Practice Address - Country:US
Practice Address - Phone:269-445-3874
Practice Address - Fax:269-445-2076
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008922207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111835668Medicaid
MI1804311-11Medicaid
MI114156529Medicaid
MISK008922OtherBLUE CROSS BLUE SHIELD
MIF16751Medicare UPIN
MI230015Medicare Oscar/Certification
MIG56008 006Medicare ID - Type UnspecifiedTHREE RIVERS HEALTH
MI110050765Medicare PIN
MI111835668Medicaid
MI0C96038011Medicare PIN