Healthcare Provider Details

I. General information

NPI: 1467800466
Provider Name (Legal Business Name): PRINCY ANN GEORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRINCY ANN KOSHY MD

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23120 N LAGRANGE RD
FRANKFORT IL
60423-7760
US

IV. Provider business mailing address

23120 N LAGRANGE RD
FRANKFORT IL
60423-7760
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-5440
  • Fax:
Mailing address:
  • Phone: 815-464-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036162093
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: