Basic Information
| Provider Information | |||||||||
| NPI: | 1588606982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOZOKI | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | CATHRYN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 MANNING DRIVE CB 7025 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198431220 | ||||||||
| FaxNumber: | 5174323928 | ||||||||
| Practice Location | |||||||||
| Address1: | 194 FINLEY GOLF COURSE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275174403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849744401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 10/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084B0040X | 4301063651 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | 2084N0400X | 01083537A | IN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084B0040X | 2020-03840 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4299577 | 05 | MI | MEDICAID | 1588606982 | 05 | MI | MEDICAID |