Individual provider Active NPI

Michael A Kozek, DDS

  • General Practice Dentistry
  • Oak Lawn, IL
National Provider Identifier
1083784367
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
4647 W 103Rd St
Suite 2-I
Oak Lawn, IL 60453-4779
Phone
(708) 423-0500
Fax
(708) 423-0501
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

4647 W 103Rd St
Suite 2-I
Oak Lawn, IL 60453-4779

Mailing address

4647 W. 103Rd Street
Suite 2-I
Oak Lawn, IL 60453-4793
Phone (708) 423-0500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160303001695 IL Order and Referring Only - DentistPractitioner - Dentist 2860798659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083784367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4647 W. 103RD STREET",
            "address_2": "SUITE 2-I",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534793",
            "telephone_number": "708-423-0500",
            "fax_number": "708-423-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4647 W 103RD ST",
            "address_2": "SUITE 2-I",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534779",
            "telephone_number": "708-423-0500",
            "fax_number": "708-423-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZEK",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.