Healthcare Provider Details

I. General information

NPI: 1174690762
Provider Name (Legal Business Name): HARRY M KOSLOWSKI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3599 UNIVERSITY BLVD S SUITE 601
JACKSONVILLE FL
32216-4252
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD S SUITE 601
JACKSONVILLE FL
32216-4252
US

V. Phone/Fax

Practice location:
  • Phone: 904-367-0707
  • Fax: 904-367-0717
Mailing address:
  • Phone: 904-367-0707
  • Fax: 904-367-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME0062907
License Number StateFL

VIII. Authorized Official

Name: HARRY M KOSLOWSKI
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 904-367-0707