Basic Information
| Provider Information | |||||||||
| NPI: | 1114974664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZLOWSKI | ||||||||
| FirstName: | TOMASZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 N CLYDE MORRIS BLVD | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864250141 | ||||||||
| FaxNumber: | 3862264577 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 N CLYDE MORRIS BLVD STE 360 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864254650 | ||||||||
| FaxNumber: | 3864257510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME139131 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | ME139131 | FL | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
ID Information
| ID | Type | State | Issuer | Description | 403029000 | 05 | MD | MEDICAID | 5901586 | 01 | NC | MPN | OTHER |