Jeremy Kudzia

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704307001 Issued in MI

Practice address

25401 Harper Ave Ste 2
Saint Clair Shores, MI 48081-2248

Phone

(586) 469-6912

NPI assigned

Aug 19, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1174922884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42383 GARFIELD RD UNIT 381131",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480387737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25401 HARPER AVE STE 2",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812248",
            "telephone_number": "586-469-6912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1305 E Eighth St Ste B",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496862981",
            "country_code": "US",
            "telephone_number": "231-922-9625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUDZIA",
        "first_name": "JEREMY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-19",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704307001",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704307001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kroger Co of Michigan (Kroger Pharmacy)
• David Walter Kroll, MD
• Barbara Danielle Krzesak
• Douglas Carl Kubek, D.O.
• Carolina Kudlawiec
• Christine Kuhl
• Jennifer Kulinski, FNP-BC
• Michelle Kurkierewicz, LPC
• Muralidharan Kurup, PHARMD
• Jennifer Kuzel, MD

• Registered Nurse in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.