Healthcare Provider Details

I. General information

NPI: 1093134702
Provider Name (Legal Business Name): ANDREW NICHOLAS KOZLOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 866-844-1411
  • Fax:
Mailing address:
  • Phone: 813-253-2721
  • Fax: 813-594-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME150521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: