Provider Demographics
NPI:1285682484
Name:ALAN KWASELOW MD, PC
Entity Type:Organization
Organization Name:ALAN KWASELOW MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWASELOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-347-8121
Mailing Address - Street 1:46325 W 12 MILE ROAD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-347-8121
Mailing Address - Fax:248-305-6254
Practice Address - Street 1:46325 W 12 MILE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-347-8121
Practice Address - Fax:248-305-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P31310Medicare PIN