=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881680411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE R SOSENKO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2005
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3825 HIGHLAND AVE SUITE 2A
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-725-9700
-----------------------------------------------------
Fax | 630-725-9703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 OLD GLENVIEW RD STE 130
-----------------------------------------------------
City | WILMETTE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60091-6505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-673-6505
-----------------------------------------------------
Fax | 847-673-2099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 036056896
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------