Healthcare Provider Details

I. General information

NPI: 1477974525
Provider Name (Legal Business Name): MARGARITA KOS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 N BROADWAY ST STE 403
CHICAGO IL
60640-7910
US

IV. Provider business mailing address

4753 N BROADWAY ST STE 403
CHICAGO IL
60640-7910
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-2780
  • Fax: 833-972-0865
Mailing address:
  • Phone: 773-989-2780
  • Fax: 833-972-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277001467
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14470
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: