Healthcare Provider Details

I. General information

NPI: 1023355369
Provider Name (Legal Business Name): TROY LEE ZUKOWSKI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 WEST WALNUT
KALAMAZOO MI
49007
US

IV. Provider business mailing address

218 WEST WALNUT CHOICES FOR CHANGE
KALAMAZOO MI
49007
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-7997
  • Fax:
Mailing address:
  • Phone: 269-344-7997
  • Fax: 269-344-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801058113
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: