Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2020-01441 | NC |
N | 207X00000X | Orthopaedic Surgeon | 72171 | WI |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 269712 | MA |
NPI | 1386937001 |
---|---|
Provider Name | Michal Kozanek |
First Address | Woburn, MA 01801-3342 |
Second Address | Woburn, MA 01801-3342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2011 |
Last Update Date | 08/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FK6059554 | ORTHOPEDICS (01) | NC |