Provider Demographics
NPI:1790984755
Name:PUSZ, MAX DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:DANIEL
Last Name:PUSZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY HEAD AND NECK SURGERY
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-524-6399
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY HEAD AND NECK SURGERY
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-524-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092366207Y00000X
CODR.0054811207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology