Provider Demographics
NPI:1700225265
Name:COSBAN, TRAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:COSBAN
Suffix:
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 1:1255 S STATE ST, UNIT 1008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:773-702-9500
Mailing Address - Fax:
Practice Address - Street 1:10780 PEBBLE HILLS BLVD STE G1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-2039
Practice Address - Country:US
Practice Address - Phone:915-773-0606
Practice Address - Fax:915-591-0726
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9980207P00000X
IL125-063711207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine