Provider Demographics
NPI:1326436767
Name:MICHAEL VOSICKY DO FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:MICHAEL VOSICKY DO FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSICKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-351-9170
Mailing Address - Street 1:245 S GARY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2228
Mailing Address - Country:US
Mailing Address - Phone:630-351-9170
Mailing Address - Fax:
Practice Address - Street 1:245 S GARY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2228
Practice Address - Country:US
Practice Address - Phone:630-351-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100201259Medicare UPIN