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NPI Code Detail

MEDICARE: COSME O LOZANO JR. M.D.

MEDICARE:   COSME O LOZANO JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician036082815IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11760647226OTHERGROUP NPI

General Provider Information

NPI Number : 1336160597
Entity Type Code : Individual
Provider Name (Legal Business Name) : COSME O LOZANO JR. M.D.
Provider Business Mailing Address
First Line : 210 N HAMMES AVE
Second Line : SUITE 205
City : JOLIET
State : IL
Zip : 60435-8139
Country : US
Telephone Number : 815-729-7790
Fax Number : 815-725-8144
Provider Business Practice Location Address
First Line : 210 N HAMMES AVE
Second Line : SUITE 205
City : JOLIET
State : IL
Zip : 60435-8139
Country : US
Telephone Number : 815-729-7790
Fax Number : 815-725-8144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2006
Last Update Date : 02/04/2025

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