Basic Information
Provider Information
NPI: 1033153960
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOZLOWSKI
FirstName: CHRISTOPHER
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1155 MILL ST # MCM14
Address2:  
City: RENO
State: NV
PostalCode: 895021576
CountryCode: US
TelephoneNumber: 7759825262
FaxNumber: 7759825496
Practice Location
Address1: 1500 E 2ND ST
Address2: SUITE 400
City: RENO
State: NV
PostalCode: 895021262
CountryCode: US
TelephoneNumber: 7759822400
FaxNumber: 7759822888
Other Information
ProviderEnumerationDate: 06/14/2006
LastUpdateDate: 12/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X15789NVN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011X15789NVY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

No ID Information.


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