Provider Demographics
NPI:1255664066
Name:GEORGE HVOSTIK, MD, S.C.
Entity Type:Organization
Organization Name:GEORGE HVOSTIK, MD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HVOSTIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-996-0836
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071912207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE48513Medicare UPIN