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NPI Code Detail

MEDICARE: MR. GERALD JOSEPH KOZAK III MPT

MEDICARE: MR. GERALD JOSEPH KOZAK III MPT
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
12251X0800XOrthopedic Physical TherapistL951582MI
2225100000XPhysical Therapist5501012904MI

General Provider Information

NPI Number : 1780720250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GERALD JOSEPH KOZAK III MPT
Provider Business Mailing Address
First Line : 24014 W RENWICK RD UNIT 206
Second Line :
City : PLAINFIELD
State : IL
Zip : 60544-8711
Country : US
Telephone Number : 800-974-4378
Fax Number : 630-515-1536
Provider Business Practice Location Address
First Line : 122 S MAIN ST
Second Line :
City : ALMONT
State : MI
Zip : 48003-1066
Country : US
Telephone Number : 800-974-4378
Fax Number : 630-515-1536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 10/24/2023

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