Healthcare Provider Details

I. General information

NPI: 1518304054
Provider Name (Legal Business Name): MARK K. KOSINSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 4900
SKOKIE IL
60076-5080
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-864-3278
  • Fax: 847-676-1727
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-570-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036140077
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036140077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: