Healthcare Provider Details

I. General information

NPI: 1124219241
Provider Name (Legal Business Name): KEVIN R KOZAK MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 14TH ST
BARABOO WI
53913-1539
US

IV. Provider business mailing address

707 14TH ST
BARABOO WI
53913-1539
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-1400
  • Fax:
Mailing address:
  • Phone: 608-356-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME148357
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036121114
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number51615
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: