Provider Demographics
NPI:1104804285
Name:KOZLOWSKI, ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KOZLOWSKI
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 ABBOT RD STE SOUTH
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3170
Mailing Address - Country:US
Mailing Address - Phone:517-299-0663
Mailing Address - Fax:517-299-0669
Practice Address - Street 1:921 ABBOT RD STE SOUTH
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3170
Practice Address - Country:US
Practice Address - Phone:517-299-0663
Practice Address - Fax:517-299-0669
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104804285Medicaid
MI853303415OtherBCBS PIN
MI200000014548OtherPHP
MI1104804285Medicaid
MI200000014548OtherPHP
MI1005282OtherMCLAREN HEALTH PLAN
MIH77063Medicare UPIN
MI4493304Medicaid
MI4762565Medicaid
MI080C310570OtherCOMMUNITY BLUE
MIOM67430011Medicare ID - Type Unspecified
MI1005282OtherHEALTH ADVANTAGE