Provider Demographics
NPI:1467641266
Name:MARY JOZWIAK MD PC
Entity Type:Organization
Organization Name:MARY JOZWIAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOZWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-237-5554
Mailing Address - Street 1:2900 12TH AVE N STE 4E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7510
Mailing Address - Country:US
Mailing Address - Phone:406-237-5554
Mailing Address - Fax:406-245-2345
Practice Address - Street 1:2900 12TH AVE N STE 4E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7510
Practice Address - Country:US
Practice Address - Phone:406-237-5554
Practice Address - Fax:406-245-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8391207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMT8391OtherMT LICENSE
MTG77864Medicare UPIN