Provider Demographics
NPI:1881633220
Name:KURETU, MWAZHUWA LEONARD RAY (MD)
Entity Type:Individual
Prefix:
First Name:MWAZHUWA
Middle Name:LEONARD RAY
Last Name:KURETU
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 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-645-3555
Mailing Address - Fax:302-644-3560
Practice Address - Street 1:400 SAVANNAH ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-0000
Practice Address - Country:US
Practice Address - Phone:302-644-4282
Practice Address - Fax:302-644-8734
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026971E208G00000X
DEC1-0009323208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001144702Medicaid
PA001144702Medicaid
PA186249Medicare ID - Type Unspecified
DE179754YAQBMedicare PIN