Basic Information
| Provider Information | |||||||||
| NPI: | 1295348142 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZELUH | ||||||||
| FirstName: | ARIANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 E HAWTHORN PKWY STE 235 | ||||||||
| Address2: | |||||||||
| City: | VERNON HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600611454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478683435 | ||||||||
| FaxNumber: | 8478595885 | ||||||||
| Practice Location | |||||||||
| Address1: | 16221 W 159TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | LOCKPORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604417902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478683435 | ||||||||
| FaxNumber: | 8478595885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 164007117 | IL | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.