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NPI Code Detail

MEDICARE: ROMAN O KOZYCKYJ MD

MEDICARE: ROMAN O KOZYCKYJ MD
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
1207R00000XInternal Medicine Physician036-063880IL
2207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician036.063880IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101625872OTHERBC BC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184603961
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROMAN O KOZYCKYJ MD
Provider Business Mailing Address
First Line : 29373 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1293
Country : US
Telephone Number : 847-390-5900
Fax Number :
Provider Business Practice Location Address
First Line : 6345 W 79TH ST
Second Line :
City : BURBANK
State : IL
Zip : 60459-1133
Country : US
Telephone Number : 844-725-5238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 01/27/2025

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Directions to “ ROMAN O KOZYCKYJ MD” Practice Location

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