Provider Demographics
NPI:1912981234
Name:KUCZYNSKI, BARBARA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:M
Last Name:KUCZYNSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5175
Mailing Address - Fax:734-743-2138
Practice Address - Street 1:330 E 14 MILE RD
Practice Address - Street 2:STE B
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017
Practice Address - Country:US
Practice Address - Phone:248-589-9500
Practice Address - Fax:248-589-9587
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063340207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G79856Medicare UPIN
ON55680Medicare ID - Type Unspecified