Provider Demographics
NPI:1447440458
Name:BARBARA H CZELUSNIAK MD
Entity type:Organization
Organization Name:BARBARA H CZELUSNIAK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CZELUSNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-782-1637
Mailing Address - Street 1:38184 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1380
Mailing Address - Country:US
Mailing Address - Phone:813-782-1637
Mailing Address - Fax:813-780-9664
Practice Address - Street 1:38184 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1380
Practice Address - Country:US
Practice Address - Phone:813-782-1637
Practice Address - Fax:813-780-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65298207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
26481OtherBCBS
FL379389300Medicaid
FL379389300Medicaid
26481OtherBCBS