Provider Demographics
NPI:1023015021
Name:HVOSTIK, GEORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:HVOSTIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 W WINCHESTER RD STE 107B
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5312
Mailing Address - Country:US
Mailing Address - Phone:847-996-0836
Mailing Address - Fax:847-996-6278
Practice Address - Street 1:1860 W WINCHESTER RD STE 107B
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5312
Practice Address - Country:US
Practice Address - Phone:847-996-0836
Practice Address - Fax:847-996-6278
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071912207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC30486OtherRR MEDICARE GROUP
IL1616108OtherBCBS
IL110059869OtherRR MEDICARE INDIVIDUAL
IL1616108OtherBCBS
IL575480Medicare ID - Type UnspecifiedGROUP NUMBER
ILC30486OtherRR MEDICARE GROUP
ILE48513Medicare UPIN
ILK01495Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER