NPIMap

Organization Active NPI

Kenneth Dziuba MD PC

  • Internal Medicine Physician
  • Eastpointe, MI
National Provider Identifier
1891955597
Registry record updated Mar 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
43010039122 Issued in MI
Legal business name
KENNETH DZIUBA MD PC
Practice address
21331 Kelly Rd
Eastpointe, MI 48021-3265
Phone
(586) 773-7780
Fax
(586) 774-9656
NPI assigned
Jun 16, 2008
Last updated
Mar 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2009

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

Authorized official

Name
Dr. Kenneth Dziuba, M.D.
Title
President
Phone
(586) 773-7780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 43010039122 MI Primary

Addresses

Primary practice location

21331 Kelly Rd
Eastpointe, MI 48021-3265

Mailing address

21331 Kelly Rd
Eastpointe, MI 48021-3265
Phone (586) 773-7780

Other identifiers 1

IdentifierTypeStateIssuer
4157965MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236643200000",
    "number": "1891955597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21331 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213265",
            "telephone_number": "586-773-7780",
            "fax_number": "586-774-9656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21331 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213265",
            "telephone_number": "586-773-7780",
            "fax_number": "586-774-9656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH DZIUBA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2009-03-10",
        "status": "A",
        "authorized_official_last_name": "DZIUBA",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-773-7780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "43010039122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4157965",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastpointe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; 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.