Provider Demographics
NPI:1336414440
Name:RONALD E KUISESKI MD PC
Entity type:Organization
Organization Name:RONALD E KUISESKI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KUSESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-696-9792
Mailing Address - Street 1:14446 E EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1409
Mailing Address - Country:US
Mailing Address - Phone:303-696-9761
Mailing Address - Fax:303-696-9791
Practice Address - Street 1:14446 E EVANS AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1409
Practice Address - Country:US
Practice Address - Phone:303-696-9761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18602261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility