Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 01926280 | IL |
NPI | 1013010651 |
---|---|
Provider Name | Dr. Yelena Y Kozlovitser |
First Address | Libertyville, IL 60048-3758 |
Second Address | Libertyville, IL 60048-3758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 22/07/2013 |