MEDICARE: DR. MARLENE REID KOSOVA DPM

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
1	213E00000X	Podiatrist	016.004406	IL

General Provider Information

NPI Number	:	1558348136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLENE REID KOSOVA DPM

Provider Business Mailing Address
First Line	:	720 BROM CT STE 201
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6534
Country	:	US
Telephone Number	:	630-355-3668
Fax Number	:	630-355-3016

Provider Business Practice Location Address
First Line	:	4805 N CLAREMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3791
Country	:	US
Telephone Number	:	312-579-3150
Fax Number	:	312-579-3151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	04/20/2026

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