Provider Demographics
NPI:1295997658
Name:PHYSICIAN HOME HEALTH
Entity type:Organization
Organization Name:PHYSICIAN HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
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:734-644-0025
Mailing Address - Street 1:32841 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1771
Mailing Address - Country:US
Mailing Address - Phone:734-644-0025
Mailing Address - Fax:
Practice Address - Street 1:32841 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1771
Practice Address - Country:US
Practice Address - Phone:734-644-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023595207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA75000Medicare UPIN