Provider Demographics
NPI:1598554461
Name:DUSZYK, KEVIN JR (PA STUDENT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DUSZYK
Suffix:JR
Gender:
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17813 KELSO DR
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-1201
Mailing Address - Country:US
Mailing Address - Phone:726-220-3027
Mailing Address - Fax:
Practice Address - Street 1:17813 KELSO DR
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-1201
Practice Address - Country:US
Practice Address - Phone:726-220-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program