Healthcare Provider Details

I. General information

NPI: 1629168489
Provider Name (Legal Business Name): KEVIN A KOZICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

IV. Provider business mailing address

14476 PARALLEL AVE
ALPENA MI
49707-7988
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-7390
  • Fax: 989-356-8013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301072813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: