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1871078667
BLAYNE S KOZELKA
LA CROSSE, WI
NPI
1871078667
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: WI 4522)
Enumeration Date
2018-09-27
Last Update Date
2018-10-12
Business Address
BLAYNE S KOZELKA PA-C
1836 SOUTH AVE
LA CROSSE, WI 54601-5429
Phone number: 608-782-7300
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Mailing Address
BLAYNE S KOZELKA PA-C
1836 SOUTH AVE
LA CROSSE, WI 54601-5429
Phone number: 608-782-7300
Copy
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