Provider Demographics
NPI:1710971155
Name:KOZIARSKI, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:KOZIARSKI
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 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7765 144TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3206
Practice Address - Country:US
Practice Address - Phone:772-388-3551
Practice Address - Fax:772-388-3557
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140256208600000X
MIJK0627222086S0102X, 2086S0127X, 2086S0129X
MI4301062722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383689447053OtherCOMMUNITY CHOICE MICHIGAN
MI5342093OtherAETNA PIN
MI020A310890OtherBCBS GROUP
MI4548645Medicaid
MI0131030OtherBLUE CARE NETWORK
MI0201310301OtherBCBS INDIVIDUAL PIN
MI1731597OtherPHYSICIAN HEALTH PLAN
MI1731597OtherPHYSICIAN HEALTH PLAN
MI0N80150Medicare PIN
MI5342093OtherAETNA PIN
MI0201310301OtherBCBS INDIVIDUAL PIN
MI383689447053OtherCOMMUNITY CHOICE MICHIGAN