Provider Demographics
NPI:1457887671
Name:BOZIK, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BOZIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 THOMPSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DONORA
Mailing Address - State:PA
Mailing Address - Zip Code:15033
Mailing Address - Country:US
Mailing Address - Phone:412-855-9608
Mailing Address - Fax:
Practice Address - Street 1:815 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:DONORA
Practice Address - State:PA
Practice Address - Zip Code:15033-2143
Practice Address - Country:US
Practice Address - Phone:412-855-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPO000075224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist