Provider Demographics
NPI:1689253650
Name:BOGUSZ, KYLE M (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:M
Last Name:BOGUSZ
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY NW STE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-779-4444
Mailing Address - Fax:360-697-2514
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY NW STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-779-4444
Practice Address - Fax:360-697-2514
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2024-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP61555946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2299844Medicaid