Basic Information
Provider Information
NPI: 1245264043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DROZDOWSKI
FirstName: GREGORY
MiddleName: PAUL
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15333 ALPINE DR
Address2:  
City: LIVONIA
State: MI
PostalCode: 481542635
CountryCode: US
TelephoneNumber: 7344329832
FaxNumber:  
Practice Location
Address1: 6223 N CANTON CENTER RD
Address2: 210
City: CANTON
State: MI
PostalCode: 481872696
CountryCode: US
TelephoneNumber: 7347371200
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X6801046303MIY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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