Mark Kannzawa, D.O., P.L.C.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MK010480 Issued in MI

Legal business name

MARK KANNZAWA, D.O., P.L.C.

Practice address

23933 Allen Rd
Ste. 1
Woodhaven, MI 48183-3372

Phone

(734) 671-1753

Fax

(734) 671-8130

NPI assigned

Nov 10, 2008

Organization subpart

No

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

Authorized official

Name

Mark Kanzawa, D.O.

Title

Owner

Phone

(734) 671-1753

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226275200000",
    "number": "1831343417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23933 ALLEN RD",
            "address_2": "STE. 1",
            "city": "WOODHAVEN",
            "state": "MI",
            "postal_code": "481833372",
            "telephone_number": "734-671-1753",
            "fax_number": "734-671-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23933 ALLEN RD",
            "address_2": "STE. 1",
            "city": "WOODHAVEN",
            "state": "MI",
            "postal_code": "481833372",
            "telephone_number": "734-671-1753",
            "fax_number": "734-671-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK KANNZAWA, D.O., P.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-10",
        "last_updated": "2008-11-10",
        "status": "A",
        "authorized_official_last_name": "KANZAWA",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-671-1753",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "MK010480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "260042656",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "5824919",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4141722",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Linley, PA-C
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• Robert E. Malone, M.D.
• Mark W Sawka MD PC
• Debra Markowsky
• Deborah Ann Martin, R.PH.
• Mazin K DDS PC
• McCreary Psychological Services, PLLC

• Psychiatry Physician in Woodhaven, MI
• Providers in Woodhaven, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.