MEDICARE: ADULT AND PEDIATRIC NEUROLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	036.133912	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720532773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT AND PEDIATRIC NEUROLOGY

Provider Business Mailing Address
First Line	:	677 CARRIAGE HILL DR
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-5402
Country	:	US
Telephone Number	:	207-408-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	9933 LAWLER AVE STE 313
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3783
Country	:	US
Telephone Number	:	847-450-7737
Fax Number	:	844-412-9768

Authorized Official
Title or Position	:	NEUROLOGIST
Name	:	DR. OLGA KOZLOVA
Credential	:	MD
Telephone Number	:	207-408-9300

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	07/27/2023

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