Basic Information
| Provider Information | |||||||||
| NPI: | 1033347265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUZICH | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 744786 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303744786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048342450 | ||||||||
| FaxNumber: | 7046715331 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 COURT DR STE 450 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046717652 | ||||||||
| FaxNumber: | 7046717656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 2022-01521 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 2022-01521 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | OS13910 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | OS13910 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 5101018249 | MI | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 018473200 | 05 | FL | MEDICAID | TLFUQ | 01 | FL | FLORIDA BLUE | OTHER |