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Individual

KONSTANTINS KOCIASVILI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3633 W LAKE AVE STE 307, GLENVIEW, IL 60026-5803
(847) 626-8722
(847) 316-9502
Mailing address
333 W DUNDEE RD, BUFFALO GROVE, IL 60089-3545
(847) 243-0355
(847) 243-0356

Taxonomy

Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
036135325
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036135325
IL
01
125052607
125052607
IL
Enumeration date
08/01/2007
Last updated
01/13/2023
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