Provider Demographics
NPI:1871605857
Name:GEORGE R SOSENKO MD LTD
Entity type:Organization
Organization Name:GEORGE R SOSENKO MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-725-9700
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL631009OtherADVOCATE HLTH PARTNERS ID
IL31600099OtherBCBS PROVIDER ID
ILDE1854OtherRAILROAD MEDICARE
IL75770OtherADVOCATE HLTH PARTNERS
IL631009OtherADVOCATE HLTH PARTNERS ID
IL=========00OtherADVOCATE HLTH CENTERS ID
ILDE1854Medicare PIN
IL31600099OtherBCBS PROVIDER ID
ILDE1854OtherRAILROAD MEDICARE
IL689351Medicare PIN