Organization
COZE HEALTH MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY B O'DONNELL MD (PHYSICIAN/OWNER)
(317) 379-3456
Entity
Organization
Contact information
Practice address
156 SAGAMORE PKWY W STE A, WEST LAFAYETTE, IN 47906-1569
(765) 204-1122
(765) 205-8322
Mailing address
156 SAGAMORE PKWY W STE A, WEST LAFAYETTE, IN 47906-1569
(765) 204-1122
(765) 205-8322
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01066964A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
01
—
01072209A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
Enumeration date
10/23/2018
Last updated
03/25/2020
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