Individual
MARINA A KUZNETSOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 PROVENA WAY STE 103, BOURBONNAIS, IL 60914-4797
(773) 564-5070
(773) 564-5071
Mailing address
PO BOX 85327, CHICAGO, IL 60689-5327
(814) 237-8627
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036090595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632270
BLUE CROSS BLUE SHIELD IL
IL
05
—
036090575
—
IL
Enumeration date
08/16/2006
Last updated
09/11/2024
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