Provider Demographics
NPI:1487681326
Name:LOZER, JAMES VINCENT (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VINCENT
Last Name:LOZER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49468-0116
Mailing Address - Country:US
Mailing Address - Phone:616-532-1078
Mailing Address - Fax:616-532-1966
Practice Address - Street 1:4243 56TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-9352
Practice Address - Country:US
Practice Address - Phone:616-532-1078
Practice Address - Fax:616-532-1966
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301004002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D145790OtherBCBS
MI0D14579Medicare ID - Type Unspecified