Provider Demographics
NPI:1407846967
Name:ROZYCKI, TODD W (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:W
Last Name:ROZYCKI
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 1:1802 DAY RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-4329
Mailing Address - Country:US
Mailing Address - Phone:574-204-7200
Mailing Address - Fax:574-252-0633
Practice Address - Street 1:1802 DAY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-4329
Practice Address - Country:US
Practice Address - Phone:574-204-7200
Practice Address - Fax:574-252-0633
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055942A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200372880Medicaid
ING95018Medicare UPIN
IN146470JJJJMedicare ID - Type Unspecified