Bozuk & Associates Surgical, Inc.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A73703 Issued in CA

Legal business name

BOZUK & ASSOCIATES SURGICAL, INC.

Practice address

1456 Professional Dr
Ste. #404
Petaluma, CA 94954-6639

Phone

(707) 763-3967

Fax

(707) 765-0554

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael Ivan Bozuk, M.D.NPI 1700800604

Title

Physician

Phone

(707) 763-3967

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael I Bozuk, M.D.

  • Surgery Physician
  • Petaluma, CA
  • NPI 1700800604
  Medicare reassignment NPD Authorized official
• Richard Eugene Altieri Perez, M.D.

  • Surgery Physician
  • Petaluma, CA
  • NPI 1245446780
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609912914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1456 PROFESSIONAL DR",
            "address_2": "STE. #404",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546639",
            "telephone_number": "707-763-3967",
            "fax_number": "707-765-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1456 PROFESSIONAL DR",
            "address_2": "STE. #404",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546639",
            "telephone_number": "707-763-3967",
            "fax_number": "707-765-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOZUK & ASSOCIATES SURGICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOZUK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "IVAN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "707-763-3967",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A73703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A737030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rob Bowman, LMFT
• Boyd Recovery LLC
• Alexander Christopher Boyer
• Christine T Boyer, D.D.S.
• Richard B Boyle, O.D.
• Michael I Bozuk, M.D.
• Braden Partners LP
• Sierra Bradford Okane
• Rebecca Branch
• Eden Buckner Brassfield

• Surgery Physician in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.