Provider Demographics
NPI:1891001921
Name:ANTHONY S KARUZA, DPM PS INC
Entity Type:Organization
Organization Name:ANTHONY S KARUZA, DPM PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KARUZA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-647-0557
Mailing Address - Street 1:3120 SQUALICUM PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1934
Mailing Address - Country:US
Mailing Address - Phone:360-647-0557
Mailing Address - Fax:360-733-2892
Practice Address - Street 1:3120 SQUALICUM PKWY STE 1
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1934
Practice Address - Country:US
Practice Address - Phone:360-647-0557
Practice Address - Fax:360-733-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0000289261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1101740Medicaid
WAT03147Medicare UPIN
WAAB01684Medicare PIN