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General NPI Number Information
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NPI Number | 1952455610
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Entity Type | Organization
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Legal Business Name | HARRY A KEZELIAN JR D P M P C
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 4160 JOHN R ST SUITE 1012
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City | DETROIT
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State | MI
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Zip | 48201-2020
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Country | US
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Telephone | 313-831-6442
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Fax |
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Provider Business Mailing Address
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Address Line | 29877 TELEGRAPH RD SUITE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1332
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Country | US
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Telephone | 248-354-0057
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Fax | 248-723-8807
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Authorized Official
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Title or Position | PRESIDENT
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Name | HARRY ALGER KEZELIAN JR.
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Credential | D.P.M.
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Telephone | 248-354-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001098
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License Number State | MI
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