Provider Demographics
NPI:1184911422
Name:COMPLETE PHYSICIANS CARE PC
Entity type:Organization
Organization Name:COMPLETE PHYSICIANS CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOZORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-709-3319
Mailing Address - Street 1:8635 NOTTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3222
Mailing Address - Country:US
Mailing Address - Phone:734-709-3319
Mailing Address - Fax:734-212-1541
Practice Address - Street 1:8635 NOTTINGHAM CT
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3222
Practice Address - Country:US
Practice Address - Phone:734-709-3319
Practice Address - Fax:734-212-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023595173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538139985OtherMEDICARE PROVIDER NUMBER OP23960