MEDICARE: BRIAN MICHAEL DOBOZI 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	207RG0100X	Gastroenterology Physician	35992	KY

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	:	1437157393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MICHAEL DOBOZI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 950296
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0296
Country	:	US
Telephone Number	:	502-893-0220
Fax Number	:	502-893-0563

Provider Business Practice Location Address
First Line	:	3950 KRESGE WAY
Second Line	:	#207
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4637
Country	:	US
Telephone Number	:	502-893-0220
Fax Number	:	502-893-0563

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/03/2020

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