Provider Demographics
NPI:1104883933
Name:KUSYK, BORYS (DPM)
Entity type:Individual
Prefix:
First Name:BORYS
Middle Name:
Last Name:KUSYK
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 1:1626 TUTTLE ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913
Mailing Address - Country:US
Mailing Address - Phone:608-355-6868
Mailing Address - Fax:608-355-7001
Practice Address - Street 1:1626 TUTTLE ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913
Practice Address - Country:US
Practice Address - Phone:608-355-6868
Practice Address - Fax:608-355-7001
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI549-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104883933Medicaid
WIK400179023Medicare PIN
WI480032912Medicare PIN
WI1007087OtherPHYSICIANS PLUS
WI43201700Medicaid
WI480032912Medicare PIN
T62518Medicare UPIN