Provider Demographics
NPI:1649482902
Name:COZADD, DANIEL R (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:COZADD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LAKE SUPERIOR RD APT 105
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6736
Mailing Address - Country:US
Mailing Address - Phone:248-459-0263
Mailing Address - Fax:
Practice Address - Street 1:1501 LAKE SUPERIOR RD APT 105
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6736
Practice Address - Country:US
Practice Address - Phone:248-459-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005282A2086S0102X
MI5101016895207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine