Provider Demographics
NPI:1497293427
Name:JOZELIC, IGOR
Entity Type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:JOZELIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 S GEKELER LN APT 15
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6461
Mailing Address - Country:US
Mailing Address - Phone:208-731-2415
Mailing Address - Fax:
Practice Address - Street 1:3695 S GEKELER LN APT 15
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6461
Practice Address - Country:US
Practice Address - Phone:208-731-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer