# KRISITI KOZLOV

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164586160
- **Authorized official:** KRISTI KOZLOV M.D. (OWNER)
- **Authorized official phone:** (312) 771-2007

## Contact information

- **Practice address:** 3100 OGDEN AVE, LISLE, IL 60532-1603
- **Practice address phone:** (630) 527-1920
- **Mailing address:** 635 N DEARBORN ST, \#2405, CHICAGO, IL 60610-4118
- **Mailing address phone:** (312) 771-2007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | IL | Yes |

## Other

- **Enumeration date:** 12/21/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 02233058 | BLUE CROSS BLUE SHIELD | IN |