Healthcare Provider Details

I. General information

NPI: 1376752634
Provider Name (Legal Business Name): MARIUSZ TOMASZ KOZIOL I M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 BIESTERFIELD RD SUITE 306 - WIMMER BUILDING
ELK GROVE VILLAGE IL
60007-3378
US

IV. Provider business mailing address

810 BIESTERFIELD RD STE 306
ELK GROVE VILLAGE IL
60007-3311
US

V. Phone/Fax

Practice location:
  • Phone: 847-357-1144
  • Fax: 847-357-9449
Mailing address:
  • Phone: 847-357-1144
  • Fax: 847-357-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036118758
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.118758
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: