Healthcare Provider Details

I. General information

NPI: 1689375768
Provider Name (Legal Business Name): OLIVIA ALEXANDRA KOZEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N COLUMBIA RD STOP 9037
GRAND FORKS ND
58202-9037
US

IV. Provider business mailing address

1301 N COLUMBIA RD STOP 9037
GRAND FORKS ND
58202-9037
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-3069
  • Fax:
Mailing address:
  • Phone: 701-777-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRL22452
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: