Provider Demographics
NPI:1285259689
Name:KOZDRON, JAMIE (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KOZDRON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 N PORT CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1275
Mailing Address - Country:US
Mailing Address - Phone:989-912-6575
Mailing Address - Fax:989-912-6013
Practice Address - Street 1:684 N PORT CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1275
Practice Address - Country:US
Practice Address - Phone:989-912-6575
Practice Address - Fax:989-912-6013
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046111207Q00000X, 390200000X
MI4301509389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program