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General NPI Number Information
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NPI Number | 1093998676
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Entity Type | Organization
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Legal Business Name | RANDY KOZEL MD
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 112 CLOCK TOWER SQ
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City | PORTSMOUTH
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State | RI
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Zip | 02871-1396
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Country | US
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Telephone | 401-683-9002
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Fax | 401-293-0330
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Provider Business Mailing Address
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Address Line | 112 CLOCK TOWER SQ
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City | PORTSMOUTH
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State | RI
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Zip | 02871-1396
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Country | US
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Telephone | 401-683-9002
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Fax | 401-293-0330
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Authorized Official
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Title or Position | OWNER
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Name | RANDY KOZEL
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Credential | MD
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Telephone | 401-683-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD07702
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License Number State | RI
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