Basic Information
Provider Information | |||||||||
NPI: | 1720063977 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KUSZ | ||||||||
FirstName: | HALINA | ||||||||
MiddleName: | G | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 401 S BALLENGER HWY | ||||||||
Address2: |   | ||||||||
City: | FLINT | ||||||||
State: | MI | ||||||||
PostalCode: | 485323638 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8103421000 | ||||||||
FaxNumber: | 8103421590 | ||||||||
Practice Location | |||||||||
Address1: | G 3499 LINDEN RD | ||||||||
Address2: |   | ||||||||
City: | FLINT | ||||||||
State: | MI | ||||||||
PostalCode: | 48507 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8107203980 | ||||||||
FaxNumber: | 8107203970 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/09/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301065881 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 0250480 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 110B56125 | 01 | MI | BLUE CHOICE | OTHER | 110B56125 | 01 | MI | BLUE CARE NETWORK | OTHER | C6874 | 01 | MI | MCARE | OTHER | 0987158 | 01 | MI | HEALTHPLUS | OTHER | 110B56125 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 110B56125 | 01 | MI | COMMUNITY BLUE PPO | OTHER | 2597259003 | 01 | MI | CIGNA | OTHER | 4154088 | 05 | MI |   | MEDICAID | 4267312 | 05 | MI |   | MEDICAID | H06856 | 01 | MI | HAP | OTHER | H06856 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER |