Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036071912 | IL |
NPI | 1023015021 |
---|---|
Provider Name | Dr. George R Hvostik |
First Address | Libertyville, IL 60048-5312 |
Second Address | Libertyville, IL 60048-5312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 21/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110059869 | RR MEDICARE INDIVIDUAL (01) | IL |
1616108 | BCBS (01) | IL |
C30486 | RR MEDICARE GROUP (01) | IL |