Provider Demographics
NPI:1689653669
Name:KOZLOWSKI, JAY H (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:H
Last Name:KOZLOWSKI
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42557 WOODWARD AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-322-3088
Mailing Address - Fax:248-322-4175
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-4764
Practice Address - Fax:248-937-4729
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041354207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M89900OtherMEDICARE GROUP PIN
MI4893226Medicaid
MI0631936OtherBCBSM PIN
MIM89900041Medicare PIN
MI0631936OtherBCBSM PIN
B46145Medicare UPIN