Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 016002547 | IL |
NPI | 1134124258 |
---|---|
Provider Name | Dr. Donald B Cosley |
First Address | Arlington Hts, IL 60005-1533 |
Second Address | Arlington Hts, IL 60005-1533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 11/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016002547 | (05) | IL |
016002547 | STATE LICENSE NUMBER (01) | IL |
6000067547 | BLUE CROSS BLUE SHIELD (01) | IL |
T36883 | (02) | IL |