Provider Demographics
NPI:1063473684
Name:ROZICH, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ROZICH
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 1:10 E HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3153
Mailing Address - Country:US
Mailing Address - Phone:803-435-5248
Mailing Address - Fax:
Practice Address - Street 1:21 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3152
Practice Address - Country:US
Practice Address - Phone:803-883-5171
Practice Address - Fax:038-435-5288
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42272207RC0000X
SC13250207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC132500Medicaid
SCSC45949988OtherMEDICARE
WI32648200Medicaid
SCSC4594F935OtherMEDICARE
WI32648200Medicaid
F61970Medicare UPIN