Provider Demographics
NPI:1235216763
Name:KOZAREK, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KOZAREK
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 1:201 W MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:46124-1346
Mailing Address - Country:US
Mailing Address - Phone:812-526-0261
Mailing Address - Fax:812-526-3118
Practice Address - Street 1:201 W MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:EDINBURGH
Practice Address - State:IN
Practice Address - Zip Code:46124-1346
Practice Address - Country:US
Practice Address - Phone:812-526-0261
Practice Address - Fax:812-526-3118
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100193720Medicaid
IN151560GGGMedicare PIN
080159270Medicare PIN
080159270Medicare PIN
IN151950AMedicare PIN