Organization
DUPAGE META-VASCULAR MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA MARY KOSIEK (RN/PRACTICE MANAGER)
(630) 893-2190
Entity
Organization
Contact information
Practice address
245 S GARY AVE, SUITE 202, BLOOMINGDALE, IL 60108-2228
(630) 893-2190
(630) 307-8716
Mailing address
245 S GARY AVE, SUITE 202, BLOOMINGDALE, IL 60108-2228
(630) 893-2190
(630) 307-8716
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
036047587
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366581811
GROUP NPI
IL
01
—
2232209
BLUE SHIELD NUMBER
IL
01
—
P00843099
RAIL ROAD
IL
Enumeration date
02/05/2007
Last updated
02/04/2011
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