Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019025216 | IL |
NPI | 1003961012 |
---|---|
Provider Name | Dr. Eva M Korzeniowski -Lyon |
First Address | Lake Forest, IL 60045-2028 |
Second Address | Deerfield, IL 60015-5646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 20/05/2013 |