Healthcare Provider Details

I. General information

NPI: 1952937831
Provider Name (Legal Business Name): LIANA N KOZANNO MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIANA NICOLE BONANNO MD, PHD

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

150 HARVESTER DR STE 300
BURR RIDGE IL
60527-5965
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number1017429
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number036170761
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: