Healthcare Provider Details

I. General information

NPI: 1649482902
Provider Name (Legal Business Name): DANIEL R COZADD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/19/2022
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LAKE SUPERIOR RD APT 105
VALPARAISO IN
46383-6736
US

IV. Provider business mailing address

1501 LAKE SUPERIOR RD APT 105
VALPARAISO IN
46383-6736
US

V. Phone/Fax

Practice location:
  • Phone: 248-459-0263
  • Fax:
Mailing address:
  • Phone: 248-459-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number02005282A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: