Provider Demographics
NPI:1790764751
Name:BOZEK, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BOZEK
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 1:2769 HEARTLAND DR STE 205
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2732
Mailing Address - Country:US
Mailing Address - Phone:319-887-2900
Mailing Address - Fax:319-887-2904
Practice Address - Street 1:2769 HEARTLAND DR STE 205
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-887-2900
Practice Address - Fax:319-887-2904
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1175943Medicaid
IA1175943Medicaid
IA53745Medicare ID - Type Unspecified