Provider Demographics
NPI:1700863784
Name:GOSZKOWICZ, KRISTA A (DPM)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:A
Last Name:GOSZKOWICZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10442 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5201
Mailing Address - Country:US
Mailing Address - Phone:708-562-1123
Mailing Address - Fax:708-562-1225
Practice Address - Street 1:10442 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5201
Practice Address - Country:US
Practice Address - Phone:708-562-1123
Practice Address - Fax:708-562-1225
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623487OtherBCBS # WESTCHESTER
IL02223079OtherBCBS # LOMBARD
IL474220Medicare PIN
ILL76207Medicare PIN
ILU72500Medicare UPIN
IL468310Medicare PIN