Provider Demographics
NPI:1093827107
Name:KOSINSKI, LAWRENCE R (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:KOSINSKI
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 1:1515 N ASTOR ST APT 21C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6711
Mailing Address - Country:US
Mailing Address - Phone:847-370-8878
Mailing Address - Fax:
Practice Address - Street 1:1515 N ASTOR ST APT 21C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6711
Practice Address - Country:US
Practice Address - Phone:847-370-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059858207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059858Medicaid
IL036059858Medicaid