MEDICARE: DR. TOMASZ KOZLOWSKI M.D.

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	208600000X	Surgery Physician	ME139131	FL
2	204F00000X	Transplant Surgery Physician	ME139131	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5901586	OTHER	NC	MPN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114974664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMASZ KOZLOWSKI M.D.

Provider Business Mailing Address
First Line	:	303 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2709
Country	:	US
Telephone Number	:	386-425-0141
Fax Number	:	386-226-4577

Provider Business Practice Location Address
First Line	:	311 N CLYDE MORRIS BLVD STE 360
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2757
Country	:	US
Telephone Number	:	386-425-4650
Fax Number	:	386-425-7510

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/12/2019

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