Provider Demographics
NPI:1316537038
Name:COZAD, RICHARD HOWARD
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HOWARD
Last Name:COZAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 HACKBERRY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301
Mailing Address - Country:US
Mailing Address - Phone:330-786-9154
Mailing Address - Fax:330-786-9154
Practice Address - Street 1:2089 HACKBERRY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301
Practice Address - Country:US
Practice Address - Phone:330-786-9154
Practice Address - Fax:330-786-9154
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7705102Medicaid