Individual
MICHAEL SEAN KOZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601-1074
(574) 400-4550
(574) 400-4551
Mailing address
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601-1074
(574) 400-4550
(574) 400-4551
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01073270A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201112880
—
IN
Enumeration date
06/14/2012
Last updated
02/12/2024
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