Healthcare Provider Details

I. General information

NPI: 1033153960
Provider Name (Legal Business Name): CHRISTOPHER M KOZLOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 2ND ST SUITE 400
RENO NV
89502-1262
US

IV. Provider business mailing address

1155 MILL ST # MCM14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-2400
  • Fax: 775-982-2888
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15789
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number15789
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: