Healthcare Provider Details

I. General information

NPI: 1285682484
Provider Name (Legal Business Name): ALAN KWASELOW MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46325 W 12 MILE RD SUITE 215
NOVI MI
48377
US

IV. Provider business mailing address

46325 W 12 MILE ROAD SUITE 215
NOVI MI
48377
US

V. Phone/Fax

Practice location:
  • Phone: 248-347-8121
  • Fax: 248-305-6254
Mailing address:
  • Phone: 248-347-8121
  • Fax: 248-305-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN KWASELOW
Title or Position: OWNER PRESIDENT
Credential: D.O.
Phone: 248-347-8121