Healthcare Provider Details

I. General information

NPI: 1679868053
Provider Name (Legal Business Name): JOHN E KLOSOWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 S VAN DYKE SUITE B
BAD AXE MI
48413
US

IV. Provider business mailing address

1100 S VAN DYKE
BAD AXE MI
48413
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-8999
  • Fax: 989-269-6174
Mailing address:
  • Phone: 989-269-9521
  • Fax: 989-269-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101019125
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: