MEDICARE: MICHAEL J. KOZEL, MD, A.P.M.C.

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	019085	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39440	OTHER	LA	BLUE CROSS
2	920794	OTHER	LA	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609039593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J. KOZEL, MD, A.P.M.C.

Provider Business Mailing Address
First Line	:	165 W OAK ST
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-3328
Country	:	US
Telephone Number	:	985-386-5943
Fax Number	:	985-386-8080

Provider Business Practice Location Address
First Line	:	165 W OAK ST
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-3328
Country	:	US
Telephone Number	:	985-386-5943
Fax Number	:	985-386-8080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL JOSEPH KOZEL
Credential	:	M.D.
Telephone Number	:	985-386-5943

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	07/09/2008

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