Provider Demographics
NPI:1285736967
Name:KOZEL, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:KOZEL
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 1:165 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-3328
Mailing Address - Country:US
Mailing Address - Phone:985-386-5943
Mailing Address - Fax:985-386-8080
Practice Address - Street 1:165 W OAK ST
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3328
Practice Address - Country:US
Practice Address - Phone:985-386-5943
Practice Address - Fax:985-386-8080
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA39440OtherBLUE CROSS BLUE SHIELD
LA920794OtherUNITED HEALTH CARE
LA1367648Medicaid
LA1367648Medicaid
53761Medicare ID - Type Unspecified