Provider Demographics
NPI:1447324330
Name:KUZEL, MARK A (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:KUZEL
Suffix:
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 1:21229 84TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7304
Mailing Address - Country:US
Mailing Address - Phone:425-775-1505
Mailing Address - Fax:425-775-9078
Practice Address - Street 1:21229 84TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7304
Practice Address - Country:US
Practice Address - Phone:425-775-1505
Practice Address - Fax:425-775-9078
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP0489213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1076256Medicaid
WA7059470Medicaid
WAULTRA SOUNDMedicaid
WA9046574Medicaid
WAG115000102Medicare ID - Type UnspecifiedMEDICARE NUMBER
WA7059470Medicaid
WA8869667Medicare PIN
WA8869666Medicare PIN