Healthcare Provider Details

I. General information

NPI: 1801805031
Provider Name (Legal Business Name): JOHN M KOSTREY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 FRANKLIN ST
DEKALB IL
60115-3742
US

IV. Provider business mailing address

217 FRANKLIN ST
DEKALB IL
60115-3742
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-8671
  • Fax:
Mailing address:
  • Phone: 815-758-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: