Healthcare Provider Details

I. General information

NPI: 1700719754
Provider Name (Legal Business Name): NICHOLAS ANTHONY GOSKA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E MADISON ST FL 3
SPRINGFIELD IL
62701-1035
US

IV. Provider business mailing address

PO BOX 19642
SPRINGFIELD IL
62794-9642
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-7627
  • Fax:
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125.088210
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.088210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: