Provider Demographics
NPI:1508852344
Name:KOSLOWSKI, HARRY M (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:M
Last Name:KOSLOWSKI
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 1:3550 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4246
Mailing Address - Country:US
Mailing Address - Phone:904-367-0707
Mailing Address - Fax:904-367-0717
Practice Address - Street 1:3550 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4246
Practice Address - Country:US
Practice Address - Phone:904-367-0707
Practice Address - Fax:904-367-0717
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME629072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372435200Medicaid
FL372435200Medicaid
FLF43695Medicare UPIN