Healthcare Provider Details

I. General information

NPI: 1104983139
Provider Name (Legal Business Name): KEVIN JOHN KOZIE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 W HIGGINS AVE
CHICAGO IL
60630
US

IV. Provider business mailing address

5411 W HIGGINS AVE
CHICAGO IL
60630
US

V. Phone/Fax

Practice location:
  • Phone: 773-725-4511
  • Fax:
Mailing address:
  • Phone: 773-725-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: