Provider Demographics
NPI:1215963194
Name:CARIOSCIA, GEORGE J (DPM)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:CARIOSCIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W. LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108
Mailing Address - Country:US
Mailing Address - Phone:630-582-3338
Mailing Address - Fax:630-582-3316
Practice Address - Street 1:117 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1006
Practice Address - Country:US
Practice Address - Phone:630-582-3338
Practice Address - Fax:630-582-3316
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004560213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU27163Medicare UPIN
ILIL5633001Medicare UPIN