MEDICARE: ANDREA PARKER KOZLOFF MD

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	4301113299	MI

General Provider Information

NPI Number	:	1902328925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA PARKER KOZLOFF MD

Provider Business Mailing Address
First Line	:	1313 STONE ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3520
Country	:	US
Telephone Number	:	810-985-2620
Fax Number	:	810-962-8290

Provider Business Practice Location Address
First Line	:	1313 STONE ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3520
Country	:	US
Telephone Number	:	810-985-2620
Fax Number	:

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

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	04/13/2026

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