Healthcare Provider Details

I. General information

NPI: 1447286653
Provider Name (Legal Business Name): RAYMOND J KOZIOL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TOWER DR DEAN MEDICAL CENTER
SUN PRAIRIE WI
53590-1239
US

IV. Provider business mailing address

10 TOWER DR DEAN MEDICAL CENTER
SUN PRAIRIE WI
53590-1239
US

V. Phone/Fax

Practice location:
  • Phone: 608-825-3008
  • Fax: 608-825-3794
Mailing address:
  • Phone: 608-825-3008
  • Fax: 608-825-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1850-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: