Healthcare Provider Details

I. General information

NPI: 1336903632
Provider Name (Legal Business Name): KYLA ASHLEY KOSIDOWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

40 E 9TH ST APT 1217
CHICAGO IL
60605-2147
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 262-501-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125086110
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: