Healthcare Provider Details

I. General information

NPI: 1326436767
Provider Name (Legal Business Name): MICHAEL VOSICKY DO FAMILY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S GARY AVE SUITE 204
BLOOMINGDALE IL
60108-2228
US

IV. Provider business mailing address

245 S GARY AVE SUITE 204
BLOOMINGDALE IL
60108-2228
US

V. Phone/Fax

Practice location:
  • Phone: 630-351-9170
  • Fax:
Mailing address:
  • Phone: 630-351-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036082782
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL VOSICKY
Title or Position: OWNER
Credential: DO
Phone: 630-351-9170