Provider Demographics
NPI:1376790071
Name:GOSKA, GREGORY W (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:GOSKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:130 N WEBER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1518
Mailing Address - Country:US
Mailing Address - Phone:630-646-5777
Mailing Address - Fax:630-646-5729
Practice Address - Street 1:130 N WEBER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1518
Practice Address - Country:US
Practice Address - Phone:630-646-5777
Practice Address - Fax:630-646-5729
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2013-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125.054143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2234311OtherBCBS
IL2234311OtherBCBS