| Coze Health Medical, Llc | |
|
156 Sagamore Pkwy W Ste A West Lafayette IN 47906-1569 | |
| (765) 204-1122 | |
| (765) 205-8322 |
| Full Name | Coze Health Medical, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 156 Sagamore Pkwy W Ste A, West Lafayette, Indiana |
| Authorized Official Name and Position | Timothy B O'donnell (PHYSICIAN/OWNER) |
| Authorized Official Contact | 3173793456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coze Health Medical, Llc 156 Sagamore Pkwy W Ste A West Lafayette IN 47906-1569 Ph: (765) 204-1122 | Coze Health Medical, Llc 156 Sagamore Pkwy W Ste A West Lafayette IN 47906-1569 Ph: (765) 204-1122 |
| NPI Number | 1356817894 |
|---|---|
| Provider Enumeration Date | 10/23/2018 |
| Last Update Date | 03/25/2020 |
| Medicare PECOS PAC ID | 4880933514 |
|---|---|
| Medicare Enrollment ID | O20190225001808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356817894 | NPI | - | NPPES |
| 01066964A | Other | IN | INDIANA PROFESSIONAL LICENSING AGENCY |
| 01072209A | Other | IN | INDIANA PROFESSIONAL LICENSING AGENCY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ruth Abramovitz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649248915 PECOS PAC ID: 8820088024 Enrollment ID: I20040518000298 |
| Provider Name | Timothy B O Donnell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144485764 PECOS PAC ID: 2769520097 Enrollment ID: I20091106000333 |
| Provider Name | Mojgan Sarmadi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033442108 PECOS PAC ID: 8628202603 Enrollment ID: I20131004000509 |
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