Organization
MARK KANNZAWA, D.O., P.L.C.
Active
Organization
MARK KANNZAWA, D.O., P.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK KANZAWA D.O. (OWNER)
(734) 671-1753
Entity
Organization
Contact information
Practice address
23933 ALLEN RD, STE. 1, WOODHAVEN, MI 48183-3372
(734) 671-1753
(734) 671-8130
Mailing address
23933 ALLEN RD, STE. 1, WOODHAVEN, MI 48183-3372
(734) 671-1753
(734) 671-8130
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MK010480
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260042656
RR MEDICARE
MI
05
—
4141722
—
MI
01
—
5824919
BCBSM
MI
Enumeration date
11/10/2008
Last updated
11/10/2008
Update your record
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