Individual
LUIS ANTONIO OSORIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7503 W CERMAK RD, NORTH RIVERSIDE, IL 60546-1405
(708) 484-6338
Mailing address
5201 WILLOW SPRINGS RD STE 150, LA GRANGE HIGHLANDS, IL 60525-6557
(708) 245-8120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36087612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001622949
BLUE CROSS BLUE SHIELD
IL
05
—
036087612
—
IL
Enumeration date
09/16/2005
Last updated
03/25/2021
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