Provider Demographics
NPI:1912973835
Name:KUZYCZ, GEORGE B (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:B
Last Name:KUZYCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N. WINFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4480
Mailing Address - Fax:630-933-2009
Practice Address - Street 1:25 N. WINFIELD RD.
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4480
Practice Address - Fax:630-933-2009
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040958208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01077990OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)
IL036040958Medicaid
ILCA4748OtherRAILROAD MEDICARE PTAN (GROUP)
206147OtherMEDICARE PTAN (GROUP)
T01703OtherMEDICARE PTAN (INDIVIDUAL)