Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | ME139131 | FL |
N | 208200000X | Surgeon | ME139131 | FL |
N | 208600000X | Surgeon | ME139131 | FL |
NPI | 1114974664 |
---|---|
Provider Name | Dr. Tomasz Kozlowski |
First Address | Daytona Beach, FL 32114-2709 |
Second Address | Daytona Beach, FL 32114-2757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 12/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
403029000 | (05) | MD |
5901586 | MPN (01) | NC |
H90308 | (02) | MD |
H90308 | (02) | NC |