Healthcare Provider Details

I. General information

NPI: 1457887671
Provider Name (Legal Business Name): MICHAEL BOZIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 THOMPSON AVE
DONORA PA
15033-2143
US

IV. Provider business mailing address

815 THOMPSON AVENUE
DONORA PA
15033
US

V. Phone/Fax

Practice location:
  • Phone: 412-855-9608
  • Fax:
Mailing address:
  • Phone: 412-855-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPO000075
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: