1679741920 NPI number — KUSSEL & ASSOCIATES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679741920 NPI number — KUSSEL & ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUSSEL & ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRED KUSSEL D.P.M.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679741920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2378 SUNSET POINT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-797-5007
Provider Business Mailing Address Fax Number:
727-725-9737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2378 SUNSET POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-797-5007
Provider Business Practice Location Address Fax Number:
727-725-9737
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KUSSEL
Authorized Official First Name:
FRED
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT / PODIATRIST
Authorized Official Telephone Number:
727-797-5007

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO 2632 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: PO2632 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 390383400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102502400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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