Provider Demographics
NPI:1437526639
Name:KAZANOWSKI, KURT (MS, RN, CHE)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:KAZANOWSKI
Suffix:
Gender:M
Credentials:MS, RN, CHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE #203
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:734-207-7558
Mailing Address - Fax:734-207-7560
Practice Address - Street 1:296 S MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4256
Practice Address - Country:US
Practice Address - Phone:734-207-7558
Practice Address - Fax:734-207-7560
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20-4094045372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion