Provider Demographics
NPI:1952478281
Name:PUZYCKI, DAVID A (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:PUZYCKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:50 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1246
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:6270 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49111-9480
Practice Address - Country:US
Practice Address - Phone:269-461-6927
Practice Address - Fax:269-461-3068
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDP065168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A110280OtherBCBS
MI0A110280OtherBCBS
MIMI2051143Medicare PIN