Provider Demographics
NPI:1255319810
Name:KOZENY, RICHARD J JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:KOZENY
Suffix:JR
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 1:226 S WOODS MILL RD
Mailing Address - Street 2:STE 43 W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3662
Mailing Address - Country:US
Mailing Address - Phone:314-205-6444
Mailing Address - Fax:314-205-6433
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:STE 43 W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-205-6444
Practice Address - Fax:314-205-6433
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34243207R00000X
MO2012037325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0238352Medicaid
IA110222391OtherRR MEDICARE
MOP01156548OtherRR MEDICARE
IA1238352Medicaid
IA1255319810Medicaid
IA2238352Medicaid
IA0238352Medicaid
IAG72944Medicare UPIN
IA1238352Medicaid