Provider Demographics
NPI:1457540536
Name:LOSZEWSKI, MARK DAVID (APRN,BC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:LOSZEWSKI
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Gender:M
Credentials:APRN,BC
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Mailing Address - Street 1:4646 JOHN R ST
Mailing Address - Street 2:MENTAL HEALTH CLINIC
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:313-576-1000
Mailing Address - Fax:313-576-1091
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:MENTAL HEALTH CLINIC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:313-576-1091
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704188696364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult