Provider Demographics
NPI:1366420432
Name:KOZLOWSKI, JOSEPH S JR (DO)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:S
Last Name:KOZLOWSKI
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:1003 E MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1822
Mailing Address - Country:US
Mailing Address - Phone:517-853-3704
Mailing Address - Fax:517-853-3701
Practice Address - Street 1:1003 E MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-1822
Practice Address - Country:US
Practice Address - Phone:517-853-3704
Practice Address - Fax:517-853-3701
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-08-28
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Provider Licenses
StateLicense IDTaxonomies
MI5101007058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI853338574OtherBCBS
MI1366420432Medicaid
MI0C36084033Medicare PIN
MIB45511Medicare UPIN