Healthcare Provider Details

I. General information

NPI: 1619127339
Provider Name (Legal Business Name): NATALIE KOZLOV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST FEINBERG 5-704
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST FEINBERG 5-704
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0061
  • Fax: 312-695-9013
Mailing address:
  • Phone: 312-695-0061
  • Fax: 312-695-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125051411
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number56290
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036129976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: