Provider Demographics
NPI:1710720396
Name:COHEN YATZIV, LIOR (MD)
Entity type:Individual
Prefix:MR
First Name:LIOR
Middle Name:
Last Name:COHEN YATZIV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:LIOR
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:820 S WOOD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-413-1657
Mailing Address - Fax:312-413-1657
Practice Address - Street 1:1740 W. TAYLOR ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:312-413-1657
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125083605207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program