Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301048125 | MI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 4301048125 | MI |
NPI | 1265482095 |
---|---|
Provider Name | Mark Robert Kurzawa |
First Address | Clinton Twp, MI 48038-1135 |
Second Address | Clinton Twp, MI 48035-2958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 18/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4813978 | (05) | MI |
4991915 | (05) | MI |
B44014 | (02) | MI |