Basic Information
| Provider Information | |||||||||
| NPI: | 1902895014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUZEL | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43800 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008480202 | ||||||||
| FaxNumber: | 5862266949 | ||||||||
| Practice Location | |||||||||
| Address1: | 21000 E 12 MILE RD | ||||||||
| Address2: | 102 | ||||||||
| City: | ST CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480811116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864475100 | ||||||||
| FaxNumber: | 5864475090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301056364 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4171202 | 05 | MI | MEDICAID |