Provider Demographics
NPI:1609039593
Name:MICHAEL J. KOZEL, MD, A.P.M.C.
Entity Type:Organization
Organization Name:MICHAEL J. KOZEL, MD, A.P.M.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-386-5943
Mailing Address - Street 1:165 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-3328
Mailing Address - Country:US
Mailing Address - Phone:985-386-5943
Mailing Address - Fax:985-386-8080
Practice Address - Street 1:165 W OAK ST
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3328
Practice Address - Country:US
Practice Address - Phone:985-386-5943
Practice Address - Fax:985-386-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA39440OtherBLUE CROSS
LA920794OtherUNITED HEALTHCARE
LA1367648Medicaid
LAB64831Medicare UPIN
LA53761Medicare PIN