Individual
DR. LORA KOSIVZOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
65 E SCOTT ST APT 14E, CHICAGO, IL 60610-5278
(312) 335-1148
(312) 335-8617
Mailing address
65 E SCOTT ST APT 14E, CHICAGO, IL 60610-5278
(312) 335-1148
(312) 335-8617
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004167
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004167
—
IL
Enumeration date
02/22/2007
Last updated
07/12/2010
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