Individual
DR. DAVID BRADLEY KOZLOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1322 TUNEBERG PKWY, BELVIDERE, IL 61008-7902
(847) 445-4262
Mailing address
1322 TUNEBERG PKWY, BELVIDERE, IL 61008-7902
(847) 445-4262
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036-100483
IL
2085R0204X
Vascular & Interventional Radiology Physician
31814
IA
2085R0204X
Vascular & Interventional Radiology Physician
43507-020
WI
2085R0204X
Vascular & Interventional Radiology Physician
ME105953
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100483
—
IL
01
—
202926
GROUP PTAN
IL
01
—
212545
GROUP PTAN
IL
Enumeration date
07/18/2006
Last updated
11/18/2023
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