Provider Demographics
NPI:1033154190
Name:PRIEB, KOSIT (MD)
Entity Type:Individual
Prefix:DR
First Name:KOSIT
Middle Name:
Last Name:PRIEB
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 1:379 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2231
Mailing Address - Country:US
Mailing Address - Phone:618-398-0231
Mailing Address - Fax:
Practice Address - Street 1:311 W LINCOLN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1902
Practice Address - Country:US
Practice Address - Phone:618-233-2500
Practice Address - Fax:618-233-2520
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0470552086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047055Medicaid
ILC37070Medicare UPIN
ILP00094Medicare ID - Type Unspecified