MEDICARE: KAMILIA F KOZLOWSKI

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	2085R0202X	Diagnostic Radiology Physician
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1790708030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMILIA F KOZLOWSKI

Provider Business Mailing Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2456
Country	:	US
Telephone Number	:	865-584-0291
Fax Number	:	865-584-4426

Provider Business Practice Location Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2456
Country	:	US
Telephone Number	:	865-584-0291
Fax Number	:	865-584-4426

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. KAMILIA KOZLOWSKI
Credential	:	MD
Telephone Number	:	865-584-0291

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/20/2021

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