MEDICARE: MR. BRYAN J KOZINSKI 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
1	207Q00000X	Family Medicine Physician	35043	TN

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

General Provider Information

NPI Number	:	1265427553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN J KOZINSKI MD

Provider Business Mailing Address
First Line	:	300 STONECREST BLVD
Second Line	:	SUITE 100
City	:	SMYRNA
State	:	TN
Zip	:	37167-5688
Country	:	US
Telephone Number	:	615-223-9502
Fax Number	:	615-223-9596

Provider Business Practice Location Address
First Line	:	300 STONECREST BLVD
Second Line	:	SUITE 100
City	:	SMYRNA
State	:	TN
Zip	:	37167-5688
Country	:	US
Telephone Number	:	615-223-9502
Fax Number	:	615-223-9596

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	04/05/2013

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