Healthcare Provider Details

I. General information

NPI: 1992874739
Provider Name (Legal Business Name): LOUIS KOZLOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVE SUITE 204
BETHESDA MD
20814-3107
US

IV. Provider business mailing address

8218 WISCONSIN AVE SUITE 204
BETHESDA MD
20814-3107
US

V. Phone/Fax

Practice location:
  • Phone: 301-652-1208
  • Fax: 301-951-8425
Mailing address:
  • Phone: 301-652-1208
  • Fax: 301-951-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0023019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: