Provider Demographics
NPI:1033510169
Name:MOSKAL, JOHN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MOSKAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 KELLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:MI
Mailing Address - Zip Code:49255-9787
Mailing Address - Country:US
Mailing Address - Phone:517-296-4369
Mailing Address - Fax:
Practice Address - Street 1:912 KELLEY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:MI
Practice Address - Zip Code:49255-9787
Practice Address - Country:US
Practice Address - Phone:517-296-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM120314997310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility