Provider Demographics
NPI:1467459792
Name:KOZACHEK, JOSEPH WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WAYNE
Last Name:KOZACHEK
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 1:441 GURLEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1415
Mailing Address - Country:US
Mailing Address - Phone:860-429-6245
Mailing Address - Fax:
Practice Address - Street 1:441 GURLEYVILLE RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-1415
Practice Address - Country:US
Practice Address - Phone:860-429-6245
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine