Individual
DR. KENNETH MICHAEL KOZLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Mailing address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301089996
MI
207XS0117X
Orthopaedic Surgery of the Spine Physician
4301089996
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201083320
—
IN
01
—
PO1223797
MEDICARE RAILROAD
MI
Enumeration date
05/31/2007
Last updated
12/12/2013
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