Healthcare Provider Details

I. General information

NPI: 1700835295
Provider Name (Legal Business Name): GERALD F KOZUH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 HOLLYWOOD RD.
ST. JOSEPH MI
49085
US

IV. Provider business mailing address

3900 HOLLYWOOD RD
SAINT JOSEPH MI
49085-9149
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-4422
  • Fax: 269-428-4411
Mailing address:
  • Phone: 269-471-7741
  • Fax: 269-471-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036049229
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301095590
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: