1609854579 NPI number — DR. KARA M KOZLOWSKI DPM, FACFAS

Table of content: DR. KARA M KOZLOWSKI DPM, FACFAS (NPI 1609854579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609854579 NPI number — DR. KARA M KOZLOWSKI DPM, FACFAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZLOWSKI
Provider First Name:
KARA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM, FACFAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609854579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3009 N BALLAS RD
Provider Second Line Business Mailing Address:
STE 100B
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-587-3668
Provider Business Mailing Address Fax Number:
636-587-3774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 N VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63025-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-587-3668
Provider Business Practice Location Address Fax Number:
636-587-3774
Provider Enumeration Date:
01/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  000651 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202141604 . This is a "CCO GENERAL MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "COMMUNITY CARE PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106623 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "GALAXY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4604670 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "EVOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "HFN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202141604 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 306929944 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 306929951 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: O86254 . This is a "EXCLUSIVE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00233973 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 231935 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4706 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 254476 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com