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General NPI Number Information
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NPI Number | 1821489097
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Entity Type | Individual
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Provider Name | MATTHEW JOHN KOSCICA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 1464
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City | CHICAGO
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State | IL
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Zip | 60602-1820
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Country | US
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Telephone | 312-600-7818
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Fax | 765-204-1880
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST STE 1464
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City | CHICAGO
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State | IL
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Zip | 60602-1820
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Country | US
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Telephone | 312-600-7818
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Fax | 765-204-1880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 125068293
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.147145
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License Number State | IL
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