Provider Demographics
NPI:1902877756
Name:KUSS, KIT D (MD)
Entity Type:Individual
Prefix:
First Name:KIT
Middle Name:D
Last Name:KUSS
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 1:1491 GOVERNORS SQUARE BLVD
Mailing Address - Street 2:STE 1200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3049
Mailing Address - Country:US
Mailing Address - Phone:850-383-3405
Mailing Address - Fax:
Practice Address - Street 1:1491 GOVERNORS SQUARE BLVD
Practice Address - Street 2:STE 1200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3049
Practice Address - Country:US
Practice Address - Phone:850-383-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00125887OtherMEDICARE RAILROAD
7868484OtherAETNA
FL967770900Medicaid
FL71661OtherBCBS
FL967770900Medicaid
FLP00125887OtherMEDICARE RAILROAD