Provider Demographics
NPI:1487645776
Name:KOSIERKIEWICZ, TOMASZ A X (MD)
Entity Type:Individual
Prefix:
First Name:TOMASZ
Middle Name:A
Last Name:KOSIERKIEWICZ
Suffix:X
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:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0044
Mailing Address - Country:US
Mailing Address - Phone:618-242-7350
Mailing Address - Fax:618-242-7651
Practice Address - Street 1:2605 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2372
Practice Address - Country:US
Practice Address - Phone:618-242-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361048262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL463609OtherHEALTHLINK
IL04130321OtherBCBS
IL130024619OtherRAILROAD MEDICARE
IL0361048261Medicaid
IL078159OtherHEALTH ALLIANCE
H46105Medicare UPIN
IL04130321OtherBCBS