Individual
JUSTIN GORDON KUSIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
192 ASHLEY AVE, CHARLESTON, SC 29403-5879
(843) 792-2731
Mailing address
192 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333, CHARLESTON, SC 29425-5075
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
LL86181
SC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/03/2021
Last updated
06/17/2021
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