Kociasvili, Konstantins
Kociasvili, Konstantins is an sole proprietor health care provider with primary practice located at 3633 W Lake Ave Ste 307 , Glenview IL 60026-5803. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as his primary health care specialty. Kociasvili, Konstantins can be contacted via phone (847) 626-8722.Contact Information
Primary practice address
3633 W Lake Ave Ste 307
Glenview IL 60026-5803
Phone: (847) 626-8722
Fax: (847) 316-9502
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adult Medicine | 207QA0505X | 036135325 | Illinois |
Profile Details
| NPI number | 1588854848 |
|---|---|
| LBN Legal business name | Kociasvili, Konstantins |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 1st, 2007 |
| Last updated | Jan 13th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588854848 | NPPES |
| Illinois | Other | 125052607 | 125052607 |
| Illinois | MEDICAID | 036135325 | 125052607 |
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