Provider Demographics
NPI:1689632994
Name:GLUSZAK, BOGUSLAW (MD)
Entity Type:Individual
Prefix:
First Name:BOGUSLAW
Middle Name:
Last Name:GLUSZAK
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 1:1767 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:NO. 255
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4906
Mailing Address - Country:US
Mailing Address - Phone:813-699-4020
Mailing Address - Fax:813-464-7682
Practice Address - Street 1:1437 S BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-2829
Practice Address - Country:US
Practice Address - Phone:727-524-4464
Practice Address - Fax:727-538-7272
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010583682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200461380Medicaid
IN945520XXXMedicare ID - Type Unspecified
IN200461380Medicaid