Basic Information
| Provider Information | |||||||||
| NPI: | 1881680411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOSENKO | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3825 HIGHLAND AVE | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307259700 | ||||||||
| FaxNumber: | 6307259703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | IL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 631009 | 01 | IL | ADVOCATE HLTH PARTNERS ID | OTHER | 75770 | 01 | IL | HEALTH PARTNERS | OTHER | P00277045 | 01 | IL | RAIL ROAD MEDICARE | OTHER | 36328327100 | 01 | IL | ADVOCATE HLTH CENTERS ID | OTHER | 31600099 | 01 | IL | BCBS PROVIDER ID | OTHER |