MEDICARE: DR. JOSEPH GERALD KOZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	4301082248	MI

General Provider Information

NPI Number	:	1487986303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH GERALD KOZA MD

Provider Business Mailing Address
First Line	:	80 E HANCOCK ST
Second Line	:	APT 903
City	:	DETROIT
State	:	MI
Zip	:	48201-1311
Country	:	US
Telephone Number	:	313-831-1147
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 E HANCOCK ST
Second Line	:	APT 903
City	:	DETROIT
State	:	MI
Zip	:	48201-1311
Country	:	US
Telephone Number	:	313-831-1147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2010
Last Update Date	:	02/02/2010

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