Provider Demographics
NPI:1952473365
Name:KUZMICKI, LEONARD MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:MICHAEL
Last Name:KUZMICKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-2235
Mailing Address - Country:US
Mailing Address - Phone:815-663-2511
Mailing Address - Fax:815-663-1237
Practice Address - Street 1:416 E DAKOTA ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-2235
Practice Address - Country:US
Practice Address - Phone:815-663-2511
Practice Address - Fax:815-663-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004619213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
998811Medicare PIN
U44977Medicare UPIN
IL1094440001Medicare NSC