Provider Demographics
NPI:1053359125
Name:JUZYCH, MARK S (MD, MHSA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:JUZYCH
Suffix:
Gender:M
Credentials:MD, MHSA
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-577-8900
Mailing Address - Fax:313-577-0700
Practice Address - Street 1:KRESGE EYE INSTITUTE
Practice Address - Street 2:4717 ST ANTOINE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-577-8900
Practice Address - Fax:313-577-0700
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-09-13
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Provider Licenses
StateLicense IDTaxonomies
MI4301054761207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630363Medicare PIN