Provider Demographics
NPI:1952937831
Name:KOZANNO, LIANA N (MD, PHD)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:N
Last Name:KOZANNO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:NICOLE
Other - Last Name:BONANNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:888-824-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017429207ZN0500X
390200000X
IL036170761207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program