MEDICARE: JOHN KOZLIK II PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1093111551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KOZLIK II PA-C

Provider Business Mailing Address
First Line	:	3990 E BROAD ST
Second Line	:	BLDG 11, SECTION 11
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1152
Country	:	US
Telephone Number	:	614-336-7376
Fax Number	:

Provider Business Practice Location Address
First Line	:	3990 E BROAD ST
Second Line	:	BLDG 11, SECTION 11
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1152
Country	:	US
Telephone Number	:	614-336-7376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/11/2014

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Directions to “ JOHN KOZLIK II PA-C” Practice Location

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