Provider Demographics
NPI:1477503217
Name:KURZAWA, MICHAEL VALENTINE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VALENTINE
Last Name:KURZAWA
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 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:586-226-6865
Mailing Address - Fax:586-226-6880
Practice Address - Street 1:25990 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-3450
Practice Address - Country:US
Practice Address - Phone:586-466-5211
Practice Address - Fax:586-466-5230
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBSM GROUP NUMBER
MI4813969Medicaid
MI5178075Medicaid
MIA76983Medicare UPIN
MAN40170066Medicare ID - Type UnspecifiedMEDICARE