Provider Demographics
NPI:1871513473
Name:KOZLOW, WENDE M (MD)
Entity type:Individual
Prefix:DR
First Name:WENDE
Middle Name:M
Last Name:KOZLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2472
Mailing Address - Country:US
Mailing Address - Phone:941-379-1777
Mailing Address - Fax:941-379-1888
Practice Address - Street 1:943 S BENEVA RD STE 210
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2472
Practice Address - Country:US
Practice Address - Phone:941-379-1777
Practice Address - Fax:941-379-1888
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100611207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149NJOtherFLORIDA BC/BS
I07506Medicare UPIN
FLDW001ZMedicare PIN