Provider Demographics
NPI:1851354278
Name:FAMSURG PLC
Entity Type:Organization
Organization Name:FAMSURG PLC
Other - Org Name:RESTORATIVE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOZIARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-979-6200
Mailing Address - Street 1:2855 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-6105
Mailing Address - Country:US
Mailing Address - Phone:269-979-6200
Mailing Address - Fax:269-979-6201
Practice Address - Street 1:2855 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-6105
Practice Address - Country:US
Practice Address - Phone:269-979-6200
Practice Address - Fax:269-979-6201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMSURG PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020A310890OtherBCBS GROUP
MIDA4938OtherRR MEDICARE GROUP
MIDA4938OtherRR MEDICARE GROUP