Provider Demographics
NPI:1891713947
Name:KOZIOL, JEFFREY E (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:KOZIOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3142
Mailing Address - Country:US
Mailing Address - Phone:847-259-2777
Mailing Address - Fax:847-437-6841
Practice Address - Street 1:1211 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3142
Practice Address - Country:US
Practice Address - Phone:847-259-2777
Practice Address - Fax:847-437-6841
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051871207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
791183572OtherMEDICARE RAILROAD RETIREM
791183572OtherMEDICARE RAILROAD RETIREM
D13477Medicare UPIN