Provider Demographics
NPI:1093111551
Name:KOZLIK, JOHN II (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KOZLIK
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 E BROAD ST
Mailing Address - Street 2:BLDG 11, SECTION 11
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1152
Mailing Address - Country:US
Mailing Address - Phone:614-336-7376
Mailing Address - Fax:
Practice Address - Street 1:3990 E BROAD ST
Practice Address - Street 2:BLDG 11, SECTION 11
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1152
Practice Address - Country:US
Practice Address - Phone:614-336-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical