Provider Demographics
NPI:1063493260
Name:DROZDOWSKI, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DROZDOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2119
Mailing Address - Country:US
Mailing Address - Phone:616-738-0737
Mailing Address - Fax:
Practice Address - Street 1:437 120TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2119
Practice Address - Country:US
Practice Address - Phone:616-738-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBD078364207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBD078364OtherSTATE LICENSE #
MI1100311602OtherBCBS MI PROV #
MI4758203Medicaid
MI35513OtherHEALTH PLAN OF MI
MIP00229880OtherRAILROAD MEDICARE
MI35513OtherHEALTH PLAN OF MI
MII32040Medicare UPIN