Healthcare Provider Details

I. General information

NPI: 1689653669
Provider Name (Legal Business Name): JAY H KOZLOWSKI M.D., F.A.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLIAM CARLS DR SUITE 100
COMMERCE TOWNSHIP MI
48382-2201
US

IV. Provider business mailing address

42557 WOODWARD AVE SUITE 130
BLOOMFIELD HILLS MI
48304-5206
US

V. Phone/Fax

Practice location:
  • Phone: 248-937-4764
  • Fax: 248-937-4729
Mailing address:
  • Phone: 248-322-3088
  • Fax: 248-322-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301041354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: