Provider Demographics
NPI:1679868053
Name:KLOSOWSKI, JOHN E (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:KLOSOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S VAN DYKE
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413
Mailing Address - Country:US
Mailing Address - Phone:989-269-9521
Mailing Address - Fax:989-269-1562
Practice Address - Street 1:1080 S VAN DYKE
Practice Address - Street 2:SUITE B
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413
Practice Address - Country:US
Practice Address - Phone:989-269-8999
Practice Address - Fax:989-269-6174
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine