Healthcare Provider Details

I. General information

NPI: 1548729411
Provider Name (Legal Business Name): LIVANA THERESA KOZNESOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 20TH ST STE 503
KNOXVILLE TN
37916-1832
US

IV. Provider business mailing address

501 20TH ST STE 503
KNOXVILLE TN
37916-1832
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-4321
  • Fax:
Mailing address:
  • Phone: 865-331-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number70372
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number70372
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: