Healthcare Provider Details

I. General information

NPI: 1720773740
Provider Name (Legal Business Name): ANYA LEI KOZA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

IV. Provider business mailing address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-7136
  • Fax: 414-219-6264
Mailing address:
  • Phone: 414-219-7136
  • Fax: 414-219-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberFK5194751
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: