Provider Demographics
NPI:1699981332
Name:KOZIOL, TRACY H (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:H
Last Name:KOZIOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5634
Mailing Address - Country:US
Mailing Address - Phone:708-562-5430
Mailing Address - Fax:708-562-8330
Practice Address - Street 1:2434 WOLF RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5634
Practice Address - Country:US
Practice Address - Phone:708-562-5430
Practice Address - Fax:708-562-8330
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-119860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL553190001Medicare PIN