Individual
LISA KOZINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5425 W LAKE ST, CHICAGO, IL 60644-2342
(773) 378-3347
(773) 378-4028
Mailing address
5425 W LAKE ST, CHICAGO, IL 60644-2342
(773) 378-3347
(773) 378-4028
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036112489
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112489
—
IL
Enumeration date
11/18/2005
Last updated
12/31/2019
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