Provider Demographics
NPI:1861512618
Name:DUZAK, KATHLEEN HELEN (DPM)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:HELEN
Last Name:DUZAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 WOODGROVE LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2673
Mailing Address - Country:US
Mailing Address - Phone:734-421-7400
Mailing Address - Fax:
Practice Address - Street 1:1770 WOODGROVE LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2673
Practice Address - Country:US
Practice Address - Phone:734-421-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKD1082213EP1101X, 213ES0131X
MI5901001082213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2122782Medicaid
MI1659512549OtherNPI
MI1861512618OtherNPI
4858250820OtherBCBS
MI11275386OtherCAQH
MI4858250820OtherBLUE CROSS BLUE SHIELD