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General NPI Number Information
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NPI Number | 1689653669
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Entity Type | Individual
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Provider Name | JAY H KOZLOWSKI M.D., F.A.C.C.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 1 WILLIAM CARLS DR SUITE 100
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-2201
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Country | US
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Telephone | 248-937-4764
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Fax | 248-937-4729
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Provider Business Mailing Address
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Address Line | 42557 WOODWARD AVE SUITE 130
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-5206
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Country | US
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Telephone | 248-322-3088
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Fax | 248-322-4175
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4301041354
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License Number State | MI
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