Provider Demographics
NPI:1063389963
Name:CHRISTOPHER KOZLOWSKI, M.D., P.C.
Entity type:Organization
Organization Name:CHRISTOPHER KOZLOWSKI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:CRAT
Authorized Official - Phone:615-474-3314
Mailing Address - Street 1:189 BERNARDO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-5139
Mailing Address - Country:US
Mailing Address - Phone:615-474-3314
Mailing Address - Fax:
Practice Address - Street 1:189 BERNARDO AVE STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-5139
Practice Address - Country:US
Practice Address - Phone:615-474-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-23
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities