Provider Demographics
NPI:1447665682
Name:BROZOVICH, JAMES NICHOLAS
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:NICHOLAS
Last Name:BROZOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:BROZOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPED
Mailing Address - Street 1:23801 BROOKPLACE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2726
Mailing Address - Country:US
Mailing Address - Phone:124-847-4622
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist