Healthcare Provider Details

I. General information

NPI: 1033855861
Provider Name (Legal Business Name): ELIZABETH KOWYNIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29405 GREENFIELD RD
SOUTHFIELD MI
48076-2226
US

IV. Provider business mailing address

29405 GREENFIELD RD
SOUTHFIELD MI
48076-2226
US

V. Phone/Fax

Practice location:
  • Phone: 248-983-5330
  • Fax: 248-327-7482
Mailing address:
  • Phone: 248-983-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: