Provider Demographics
NPI:1376752634
Name:KOZIOL, MARIUSZ T I (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIUSZ
Middle Name:T
Last Name:KOZIOL
Suffix:I
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:810 BIESTERFIELD ROAD
Mailing Address - Street 2:SUITE 306 - WIMMER BUILDING
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3378
Mailing Address - Country:US
Mailing Address - Phone:847-357-1144
Mailing Address - Fax:847-357-9449
Practice Address - Street 1:810 BIESTERFIELD RD
Practice Address - Street 2:SUITE 306 - WIMMER BUILDING
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3378
Practice Address - Country:US
Practice Address - Phone:847-357-1144
Practice Address - Fax:847-357-9449
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.118758207V00000X
IL036-118758207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118758-1Medicaid
11790234OtherCAQH