MEDICARE: DR. JAY H KOZLOWSKI M.D., F.A.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	4301041354	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0M89900	OTHER	MI	MEDICARE GROUP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0631936	OTHER	MI	BCBSM PIN

General Provider Information

NPI Number	:	1689653669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY H KOZLOWSKI M.D., F.A.C.C.

Provider Business Mailing Address
First Line	:	42557 WOODWARD AVE
Second Line	:	SUITE 130
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5206
Country	:	US
Telephone Number	:	248-322-3088
Fax Number	:	248-322-4175

Provider Business Practice Location Address
First Line	:	1 WILLIAM CARLS DR
Second Line	:	SUITE 100
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-2201
Country	:	US
Telephone Number	:	248-937-4764
Fax Number	:	248-937-4729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	09/19/2013

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