Individual
DR. BRUCE IAN KACZANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
24725 W 12 MILE RD, STE 270, SOUTHFIELD, MI 48034-8310
(248) 353-9300
(248) 353-9303
Mailing address
24725 W 12 MILE RD, STE 270, SOUTHFIELD, MI 48034-8310
(248) 353-9300
(248) 353-9303
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
BK001054
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000002793
CAPE
MI
01
—
101509
GREAT LAKES
MI
01
—
104550400
US DEP
MI
05
—
4188228
—
MI
01
—
480029296
TRICARE
MI
01
—
503536
CARE CHOICE
MI
01
—
83291
OMNI
MI
01
—
C6928
MCARE
MI
01
—
T34322
HEALTH ALLIANCE PLAN
MI
Enumeration date
06/23/2005
Last updated
08/08/2012
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