Basic Information
| Provider Information | |||||||||
| NPI: | 1093767758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUSIENSKI | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 WILEY ST | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330206548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549220706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3301 COLLEGE AVE | ||||||||
| Address2: | NSU SPORTS MEDICINE CLINIC @ UNIVERSITY CENTER, RM 1433 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333147721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542625590 | ||||||||
| FaxNumber: | 9542625970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | OS8756 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | U4311 | 05 | FL | MEDICAID |