Healthcare Provider Details

I. General information

NPI: 1952548778
Provider Name (Legal Business Name): ANTHONY P KOZMA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26861 W RIVER RD
GROSSE ILE MI
48138-2135
US

IV. Provider business mailing address

26861 W RIVER RD
GROSSE ILE MI
48138-2135
US

V. Phone/Fax

Practice location:
  • Phone: 313-283-4490
  • Fax:
Mailing address:
  • Phone: 313-283-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number5101005530
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: