Provider Demographics
NPI:1942264171
Name:KOZLEK, THOMAS FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANCIS
Last Name:KOZLEK
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:PO BOX 31001-0698
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0698
Mailing Address - Country:US
Mailing Address - Phone:602-263-1200
Mailing Address - Fax:602-263-1618
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:PHOENIX INDIAN MEDICAL CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1200
Practice Address - Fax:602-263-1618
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093278207Y00000X
PAMD009965E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000604893Medicaid
MI0F96004OtherGROUP MEDICARE ID NUMBER
867633OtherGROUP MEDICARE #
PAMD009965EOtherMEDICAL LICENSE
PAAK9631739OtherDEA
PAAK9631739OtherDEA
ME002972802Medicare PIN
PA000604893Medicaid