Provider Demographics
NPI:1770180549
Name:GOSIC, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GOSIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 BUTTERFIELD RD STE 116
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5620
Mailing Address - Country:US
Mailing Address - Phone:708-364-0580
Mailing Address - Fax:
Practice Address - Street 1:15010 S RAVINIA AVE STE 15
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5353
Practice Address - Country:US
Practice Address - Phone:708-364-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10334104772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty