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General NPI Number Information
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NPI Number | 1700839602
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Entity Type | Organization
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Legal Business Name | PRAIRIE RHEUMATOLOGY ASSOCIATES, S.C.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 903 129TH INFANTRY DR SUITE 600
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City | JOLIET
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State | IL
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Zip | 60435-3170
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Country | US
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Telephone | 815-744-7246
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Fax | 815-744-7346
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Provider Business Mailing Address
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Address Line | 903 129TH INFANTRY DR SUITE 600
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City | JOLIET
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State | IL
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Zip | 60435-3170
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Country | US
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Telephone | 815-744-7246
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Fax | 815-744-7346
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA C SOSENKO
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Credential | M.D.
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Telephone | 815-744-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 042618784
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License Number State | IL
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