Provider Demographics
NPI:1689865040
Name:KURYLOWICZ, MARTIN STEVEN (MS, LLP)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:STEVEN
Last Name:KURYLOWICZ
Suffix:
Gender:M
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-7911
Mailing Address - Country:US
Mailing Address - Phone:248-921-3249
Mailing Address - Fax:
Practice Address - Street 1:4005 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-7911
Practice Address - Country:US
Practice Address - Phone:248-921-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical