Healthcare Provider Details

I. General information

NPI: 1912908914
Provider Name (Legal Business Name): WILLIAM J KOZAK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 MEMORIAL BLVD
CONNELLSVILLE PA
15425-1488
US

IV. Provider business mailing address

506 ATHENA DR
DELMONT PA
15626-1005
US

V. Phone/Fax

Practice location:
  • Phone: 724-626-0700
  • Fax: 724-626-8700
Mailing address:
  • Phone: 724-468-6869
  • Fax: 724-468-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD422207
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: