Provider Demographics
NPI:1437157393
Name:DOBOZI, BRIAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:DOBOZI
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:PO BOX 950296
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0296
Mailing Address - Country:US
Mailing Address - Phone:502-893-0220
Mailing Address - Fax:502-893-0563
Practice Address - Street 1:3950 KRESGE WAY
Practice Address - Street 2:#207
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4637
Practice Address - Country:US
Practice Address - Phone:502-893-0220
Practice Address - Fax:502-893-0563
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35992207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200495570Medicaid
IN242500FMedicare ID - Type Unspecified
H47462Medicare UPIN