Provider Demographics
NPI:1851406920
Name:KOZLEVCHAR, JOHN J (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KOZLEVCHAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GRAPE ST
Mailing Address - Street 2:MC3800
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-1144
Mailing Address - Country:US
Mailing Address - Phone:303-436-6000
Mailing Address - Fax:
Practice Address - Street 1:3900 GRAPE ST
Practice Address - Street 2:MC3800
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1144
Practice Address - Country:US
Practice Address - Phone:303-436-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66377544Medicaid
CO66377544Medicaid
COD11559Medicare ID - Type Unspecified