Provider Demographics
NPI:1811968001
Name:KOZLOW, DANIEL B (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:KOZLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:23874 KEAN ST
Mailing Address - Street 2:STE 130
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1851
Mailing Address - Country:US
Mailing Address - Phone:313-626-0909
Mailing Address - Fax:313-551-5688
Practice Address - Street 1:23874 KEAN ST # 130
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-626-0909
Practice Address - Fax:135-515-6883
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5307000624207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4243947Medicaid
MIF48186Medicare UPIN
MI0390900001Medicare NSC
MI4243947Medicaid