Healthcare Provider Details

I. General information

NPI: 1609854579
Provider Name (Legal Business Name): KARA M KOZLOWSKI DPM, FACFAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N VIRGINIA AVE
EUREKA MO
63025-1115
US

IV. Provider business mailing address

3009 N BALLAS RD STE 100B
SAINT LOUIS MO
63131-2322
US

V. Phone/Fax

Practice location:
  • Phone: 636-587-3668
  • Fax: 636-587-3774
Mailing address:
  • Phone: 636-587-3668
  • Fax: 636-587-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000651
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: