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NPI Code Detail

MEDICARE: JEFFREY COSBY

MEDICARE: JEFFREY COSBY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorIL
2101Y00000XCounselorIL

General Provider Information

NPI Number : 1811631880
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY COSBY
Provider Business Mailing Address
First Line : 3408 W ROOSEVELT RD
Second Line :
City : CHICAGO
State : IL
Zip : 60624-4338
Country : US
Telephone Number : 773-826-2929
Fax Number : 773-826-2964
Provider Business Practice Location Address
First Line : 3408 W ROOSEVELT RD
Second Line :
City : CHICAGO
State : IL
Zip : 60624-4338
Country : US
Telephone Number : 773-826-2929
Fax Number : 773-826-2964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2022
Last Update Date : 05/07/2024

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