Individual
MAUREEN KOZLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 S LAKE PARK AVE STE 110, HOBART, IN 46342-6638
(219) 947-6017
(219) 947-6018
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
00000000A
IN
363A00000X
Physician Assistant
Primary
10003398A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300054941
—
IN
Enumeration date
09/09/2021
Last updated
10/07/2021
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