Healthcare Provider Details

I. General information

NPI: 1912830373
Provider Name (Legal Business Name): NATHAN MICHAEL KUJACZNSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CESAR E CHAVEZ AVE
LANSING MI
48906-4384
US

IV. Provider business mailing address

1321 W GRAND RIVER AVE APT 61C
EAST LANSING MI
48823-3929
US

V. Phone/Fax

Practice location:
  • Phone: 517-273-2706
  • Fax:
Mailing address:
  • Phone: 269-330-5478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120280
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: