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NPI Code Detail

MEDICARE: DR. TRAVIS MICHAEL KOZAK MD, MBA

MEDICARE: DR. TRAVIS MICHAEL KOZAK MD, MBA
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
1208000000XPediatrics Physician2026-01980NC

General Provider Information

NPI Number : 1528758190
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRAVIS MICHAEL KOZAK MD, MBA
Provider Business Mailing Address
First Line : 6010 CARNEGIE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-4637
Country : US
Telephone Number : 704-384-9966
Fax Number :
Provider Business Practice Location Address
First Line : 6010 CARNEGIE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-4637
Country : US
Telephone Number : 704-384-9966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2023
Last Update Date : 05/18/2026

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