Healthcare Provider Details

I. General information

NPI: 1770112120
Provider Name (Legal Business Name): SARAH GRACE KOZAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH GRACE GAWRONSKI

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 JOLLY RD
OKEMOS MI
48864-3553
US

IV. Provider business mailing address

PO BOX 734244
CHICAGO IL
60673-4244
US

V. Phone/Fax

Practice location:
  • Phone: 517-993-5900
  • Fax: 734-464-0335
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: