Kenneth John Dziuba, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

KD039122 Issued in MI

Practice address

24400 Greater Mack Ave
Saint Clair Shores, MI 48080-1340

Phone

(586) 778-1881

Fax

(586) 778-0667

NPI assigned

Jan 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Waypointe Internal Medicine, P.C.

  • Internal Medicine Physician
  • St Clair Shores, MI
  • NPI 1649240516
  NPD (past)

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478822400000",
    "number": "1891775938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24400 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801340",
            "telephone_number": "586-778-1881",
            "fax_number": "586-778-0667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24400 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801340",
            "telephone_number": "586-778-1881",
            "fax_number": "586-778-0667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIUBA",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2016-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "KD039122",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "KD039122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4157965",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riley Duryea
• Amy Marie Duval
• Norman Paul Dwaihy, PHD
• Heather Dyer
• Devan Dykstra
• Andrew I. Dzul, M.D.
• E&N Greater Mack Practices PLLC
• E&N Greater Mack Practices PLLC
• East Side Foot & Ankle Clinic PC
• East Side Medical Services P C

• Internal Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2016; 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.