Healthcare Provider Details

I. General information

NPI: 1194483776
Provider Name (Legal Business Name): SABINA K KOZLOWSKI DN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 AUDREY LN
MOUNT PROSPECT IL
60056-2806
US

IV. Provider business mailing address

204 AUDREY LN
MOUNT PROSPECT IL
60056-2806
US

V. Phone/Fax

Practice location:
  • Phone: 773-328-0637
  • Fax:
Mailing address:
  • Phone: 773-328-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number181.000407
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number181.000407
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number181.000407
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181.000407
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: