Provider Demographics
NPI:1952361057
Name:SLUZEWSKI, RICHARD E JR (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:SLUZEWSKI
Suffix:JR
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 1:513 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-836-1021
Mailing Address - Fax:219-836-1022
Practice Address - Street 1:513 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-1021
Practice Address - Fax:219-836-1022
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000343A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100141850AMedicaid
IN387150Medicare PIN
U22678Medicare UPIN
IN100141850AMedicaid