Organization
KRISITI KOZLOV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI KOZLOV M.D. (OWNER)
(312) 771-2007
Entity
Organization
Contact information
Practice address
3100 OGDEN AVE, LISLE, IL 60532-1603
(630) 527-1920
Mailing address
635 N DEARBORN ST, #2405, CHICAGO, IL 60610-4118
(312) 771-2007
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02233058
BLUE CROSS BLUE SHIELD
IN
Enumeration date
12/21/2006
Last updated
08/22/2020
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