Healthcare Provider Details

I. General information

NPI: 1194936393
Provider Name (Legal Business Name): ELISABETH L COZAD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISABETH LINNEA COZAD DELLICATE D.O.

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

IV. Provider business mailing address

36123 SCHOOLCRAFT RD
LIVONIA MI
48150-1216
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2000
  • Fax:
Mailing address:
  • Phone: 913-660-1616
  • Fax: 913-660-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number05-33648
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2009001599
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number05-33648
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2009001599
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: