Provider Demographics
NPI:1821078759
Name:KOSS, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:KOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE 465
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-825-1100
Mailing Address - Fax:847-825-0994
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 465
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-825-1100
Practice Address - Fax:847-825-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2019-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.071750207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071750Medicaid
ILC51012Medicare UPIN
IL246240Medicare ID - Type UnspecifiedPROVIDER #
ILL58331Medicare PIN