Active NPI
Yelena Y Kozlovitser, DDS
- Dentist
- Libertyville, IL
National Provider Identifier
1013010651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 01926280
- Practice address
- 1113 S Milwaukee Ave
Suite #103
Libertyville, IL 60048-3758 - Phone
- (847) 362-7710
- Fax
- (847) 362-7780
- NPI assigned
- Sep 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 01926280 | IL | Primary |
Addresses
Primary practice location
1113 S Milwaukee Ave
Suite #103
Libertyville, IL 60048-3758
Mailing address
1113 S Milwaukee Ave
Suite #103
Libertyville, IL 60048-3758
Phone (847) 362-7710
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01926280 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374451200000",
"number": "1013010651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1113 S MILWAUKEE AVE",
"address_2": "SUITE #103",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483758",
"telephone_number": "847-362-7710",
"fax_number": "847-362-7780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1113 S MILWAUKEE AVE",
"address_2": "SUITE #103",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483758",
"telephone_number": "847-362-7710",
"fax_number": "847-362-7780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOZLOVITSER",
"first_name": "YELENA",
"middle_name": "Y",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-07",
"last_updated": "2013-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "01926280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.