Healthcare Provider Details

I. General information

NPI: 1467641266
Provider Name (Legal Business Name): MARY JOZWIAK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N STE 4E
BILLINGS MT
59101-7510
US

IV. Provider business mailing address

2900 12TH AVE N STE 4E
BILLINGS MT
59101-7510
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5554
  • Fax: 406-245-2345
Mailing address:
  • Phone: 406-237-5554
  • Fax: 406-245-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8391
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8391
License Number StateMT

VIII. Authorized Official

Name: MARY JOZWIAK
Title or Position: OWNER
Credential: MD
Phone: 406-237-5554