Provider Demographics
NPI:1043425945
Name:KOZINN, JONATHAN BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BENJAMIN
Last Name:KOZINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4407
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:ATTN: PBS
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-7940
Practice Address - Fax:816-932-9670
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012810207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204929202Medicaid
MOJ11F446Medicare PIN
MO204929202Medicaid
MOS55F446Medicare PIN