NPIMap

Individual provider Active NPI

Mark Robert Kurzawa, MD

  • Family Medicine Physician
  • Clinton TWP, MI
National Provider Identifier
1265482095
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301048125 Issued in MI
Practice address
36367 Harper Ave
Clinton TWP, MI 48035-2958
Phone
(586) 791-6868
Fax
(586) 791-5071
NPI assigned
May 11, 2006
Last updated
Jan 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301048125 MI Primary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 4301048125 MI

Addresses

Primary practice location

36367 Harper Ave
Clinton TWP, MI 48035-2958

Mailing address

43750 Garfield Rd
Suite 104
Clinton TWP, MI 48038-1135
Phone (586) 226-6865

Other identifiers 2

IdentifierTypeStateIssuer
4813978MedicaidMI
4991915MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060103000605 MI Practitioner - Family PracticePractitioner - Geriatric Medicine 2163444290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Wayne State University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Semi Medical GroupGroup PAC ID 0648180406, shared by 4 NPIs, 246 clinicians
Henry Ford Cornerstone Medical GroupGroup PAC ID 7517162761, 65 clinicians

Practice addresses (Care Compare)

17900 23 Mile Rd
Macomb, MI 48044-1161
Phone (313) 647-3900

36367 Harper Ave
Clinton Township, MI 48035-2958
Phone (586) 791-6868

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301048125MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Cornerstone Medical Group Family Medicine CurrentSince Jan 1, 2016 Accepting new patients

Locations

4260 Van Dyke Rd
Ste 102
Almont, MI 48003
Phone (810) 798-3994

36367 Harper Ave
Clinton Twp, MI 48035
Phone (313) 791-6868

43900 Garfield Rd
Ste 222
Clinton Twp, MI 48038
Phone (586) 263-1234

46591 Romeo Plank Rd
Macomb, MI 48044
Phone (586) 226-6269

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/mQjCqHb5rkr1u1foU4dqhQPBpi7Qk9R4/
  • Direct secure messaging: mark.kurzawa.2@8209.direct.athenahealth.com
  • Direct secure messaging: mkurzawa1135479@direct.hfhs.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200614400000",
    "number": "1265482095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43750 GARFIELD RD",
            "address_2": "SUITE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381135",
            "telephone_number": "586-226-6865",
            "fax_number": "586-226-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36367 HARPER AVE",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480352958",
            "telephone_number": "586-791-6868",
            "fax_number": "586-791-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KURZAWA",
        "first_name": "MARK",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2008-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301048125",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4301048125",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4813978",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4991915",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

Verify at the official NPI Registry.