Provider Demographics
NPI:1952548778
Name:KOZMA, ANTHONY P (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:KOZMA
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 1:26861 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2135
Mailing Address - Country:US
Mailing Address - Phone:313-283-4490
Mailing Address - Fax:
Practice Address - Street 1:26861 W RIVER RD
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2135
Practice Address - Country:US
Practice Address - Phone:313-283-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010055302085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging