Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 036-047055 | IL |
NPI | 1033154190 |
---|---|
Provider Name | Dr. Kosit Prieb |
First Address | Belleville, IL 62223-2231 |
Second Address | Belleville, IL 62220-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036047055 | (05) | IL |
C37070 | (02) | IL |