Provider Demographics
NPI:1720306590
Name:KOZICZKOWSKI, RACHEL ADE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ADE
Last Name:KOZICZKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7159
Mailing Address - Country:US
Mailing Address - Phone:309-623-7100
Mailing Address - Fax:
Practice Address - Street 1:870 36TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7159
Practice Address - Country:US
Practice Address - Phone:309-623-7100
Practice Address - Fax:309-623-7079
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.140268207N00000X, 207ND0101X
WI390200000X207N00000X
MO2019016837207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery