MEDICARE: MS. KIMBERLY HARMON ROZNOWSKI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C0002865	MD
2	363A00000X	Physician Assistant		MI

General Provider Information

NPI Number	:	1053399865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY HARMON ROZNOWSKI PA-C

Provider Business Mailing Address
First Line	:	441 S LIVERNOIS RD STE 100
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2585
Country	:	US
Telephone Number	:	248-608-8800
Fax Number	:	248-608-2490

Provider Business Practice Location Address
First Line	:	441 S LIVERNOIS RD STE 100
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2585
Country	:	US
Telephone Number	:	248-608-8800
Fax Number	:	248-608-2490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	08/06/2021

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