Healthcare Provider Details

I. General information

NPI: 1689691164
Provider Name (Legal Business Name): KARA KOZLOSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE SUITE 106
DU BOIS PA
15801-1462
US

IV. Provider business mailing address

PO BOX 447
DU BOIS PA
15801-0447
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3911
  • Fax: 814-375-4424
Mailing address:
  • Phone: 814-375-3911
  • Fax: 814-375-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-008945-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: