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Individual

DR. LEO KUSUDA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4574
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4574

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD27316
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0577260001
DMERC
OR
01
1407812365
MEDICARE GROUP NPI NUMBER
OR
01
161133
NBMC GROUP MEDICAID
OR
05
218174
OR
01
CB3544
RR MEDICARE GROUP NUMBER
OR
01
P00406434
RR PTAN MEDICARE NUMBER
OR
01
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
01/24/2006
Last updated
02/27/2012
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