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General NPI Number Information
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NPI Number | 1154116747
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Entity Type | Individual
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Provider Name | LISA KOZODOY MD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD STE 2009B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8265
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Country | US
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Telephone | 314-251-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 13215 2ND AVE S
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City | BURIEN
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State | WA
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Zip | 98168-2637
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Country | US
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Telephone | 206-687-8336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2025021583
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License Number State | MO
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