Provider Demographics
NPI:1609807908
Name:VOSICKY, MICHAEL F (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:VOSICKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SPRINGFIELD DR
Mailing Address - Street 2:STE 290
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2293
Mailing Address - Country:US
Mailing Address - Phone:630-351-9170
Mailing Address - Fax:630-439-3196
Practice Address - Street 1:290 SPRINGFIELD DR STE 290
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2293
Practice Address - Country:US
Practice Address - Phone:630-351-9170
Practice Address - Fax:630-439-3196
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL47-2585424OtherTAX ID
IL0222075OtherBLUE CROSS GROUP NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
ILF400201265Medicare PIN
IL482450Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL0222075OtherBLUE CROSS GROUP NUMBER