Provider Demographics
NPI:1093707796
Name:COSCINO, JOSEPH M (PC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:COSCINO
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S067 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3978
Mailing Address - Country:US
Mailing Address - Phone:630-261-9500
Mailing Address - Fax:630-261-9504
Practice Address - Street 1:1S067 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3978
Practice Address - Country:US
Practice Address - Phone:630-261-9500
Practice Address - Fax:630-261-9504
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004563213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60010824OtherBC/BS
IL016004563Medicaid
ILL20599Medicare PIN
IL016004563Medicaid
IL480013478Medicare PIN
ILU32160Medicare UPIN
IL480014875Medicare PIN
IL995130Medicare PIN
ILL74861Medicare PIN
IL560760005Medicare PIN
ILL74860Medicare PIN
IL4480800001Medicare NSC