Provider Demographics
NPI:1881680411
Name:SOSENKO, GEORGE R (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:SOSENKO
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-725-9700
Practice Address - Fax:630-725-9703
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL631009OtherADVOCATE HLTH PARTNERS ID
IL75770OtherHEALTH PARTNERS
ILP00277045OtherRAIL ROAD MEDICARE
IL36328327100OtherADVOCATE HLTH CENTERS ID
IL31600099OtherBCBS PROVIDER ID
IL31600099OtherBCBS PROVIDER ID
IL631009OtherADVOCATE HLTH PARTNERS ID
IL75770OtherHEALTH PARTNERS
IL36328327100OtherADVOCATE HLTH CENTERS ID