Provider Demographics
NPI:1114974664
Name:KOZLOWSKI, TOMASZ (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMASZ
Middle Name:
Last Name:KOZLOWSKI
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 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-425-0141
Mailing Address - Fax:386-226-4577
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 360
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2757
Practice Address - Country:US
Practice Address - Phone:386-425-4650
Practice Address - Fax:386-425-7510
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139131208600000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403029000Medicaid
NC5901586OtherMPN
NC5901586OtherMPN
MDH90308Medicare UPIN
MD403029000Medicaid