Basic Information
| Provider Information | |||||||||
| NPI: | 1851322275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZLOV | ||||||||
| FirstName: | ILYA | ||||||||
| MiddleName: | YUREVICH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 GRAND CONCOURSE | ||||||||
| Address2: | 5TH FL ADMIN - DEPT OF OBGYN | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182398383 | ||||||||
| FaxNumber: | 7182398360 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182398383 | ||||||||
| FaxNumber: | 7182398360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 230644 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.