Provider Demographics
NPI:1306026521
Name:KOZLOWSKI, MICHAEL GENE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GENE
Last Name:KOZLOWSKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2462 JOHN R RD
Mailing Address - Street 2:#202
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2587
Mailing Address - Country:US
Mailing Address - Phone:248-343-5260
Mailing Address - Fax:
Practice Address - Street 1:3990 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:952-442-9770
Practice Address - Fax:952-442-3620
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230494367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered