MEDICARE: LUIS ANTONIO OSORIO 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
1	207Q00000X	Family Medicine Physician	36087612	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0001622949	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1568457455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ANTONIO OSORIO M.D.

Provider Business Mailing Address
First Line	:	5201 WILLOW SPRINGS RD STE 150
Second Line	:
City	:	LA GRANGE HIGHLANDS
State	:	IL
Zip	:	60525-6557
Country	:	US
Telephone Number	:	708-245-8120
Fax Number	:

Provider Business Practice Location Address
First Line	:	7503 W CERMAK RD
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1405
Country	:	US
Telephone Number	:	708-484-6338
Fax Number	:

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	03/25/2021

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