Basic Information
| Provider Information | |||||||||
| NPI: | 1013960921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOZIC | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 BARBARA JORDAN BLVD | ||||||||
| Address2: | DEPT OF SURGERY AND PERIOPERATIVE CARE - STE. 1.114 AC | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787233092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124955089 | ||||||||
| FaxNumber: | 5123248906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 38TH ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124544561 | ||||||||
| FaxNumber: | 5124067330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 12/29/2015 | ||||||||
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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 | 207X00000X | A81571 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | Q3646 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00A815710 | 05 | CA | MEDICAID | 351396201 | 05 | TX | MEDICAID |