Healthcare Provider Details

I. General information

NPI: 1023272689
Provider Name (Legal Business Name): BRIAN KOSAN ATC, NRP, OTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N HIGHLAND AVE
AURORA IL
60506-1404
US

IV. Provider business mailing address

1221 N HIGHLAND AVE
AURORA IL
60506-1404
US

V. Phone/Fax

Practice location:
  • Phone: 630-264-8720
  • Fax:
Mailing address:
  • Phone: 630-264-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number060024957
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096002623
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: