Provider Demographics
NPI:1134166879
Name:KOZLOFF, MARK F (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:KOZLOFF
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 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-339-4800
Practice Address - Fax:708-339-3760
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038049A207RH0003X
ILIL036047581207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047581Medicaid
IN200016510FMedicaid
IL036047581Medicaid
IN200016510FMedicaid
IL437901Medicare ID - Type UnspecifiedIL MCARE GROUP PROV #
IN626820Medicare ID - Type UnspecifiedIN MCARE GROUP PROV #
INCE1551Medicare ID - Type UnspecifiedIN R R MCARE GRP #
C37821Medicare UPIN
ILPO1126Medicare PIN