Healthcare Provider Details

I. General information

NPI: 1336160597
Provider Name (Legal Business Name): COSME O LOZANO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N HAMMES AVE SUITE 205
JOLIET IL
60435-8139
US

IV. Provider business mailing address

210 N HAMMES AVE SUITE 205
JOLIET IL
60435-8139
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-7790
  • Fax: 815-725-8144
Mailing address:
  • Phone: 815-729-7790
  • Fax: 815-725-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036082815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: