Provider Demographics
NPI:1336160597
Name:LOZANO, COSME O JR (MD)
Entity type:Individual
Prefix:
First Name:COSME
Middle Name:O
Last Name:LOZANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HAMMES AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8139
Mailing Address - Country:US
Mailing Address - Phone:815-729-7790
Mailing Address - Fax:815-725-8144
Practice Address - Street 1:210 N HAMMES AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8139
Practice Address - Country:US
Practice Address - Phone:815-729-7790
Practice Address - Fax:815-725-8144
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360828152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760647226OtherGROUP NPI
1407971716OtherLAKEWOOD NPI
IL145618Medicare PIN
IL145710Medicare PIN
IL145892Medicare PIN
IL260025882Medicare PIN
1407971716OtherLAKEWOOD NPI
IL145316Medicare PIN
IL146061Medicare PIN
IL211727Medicare PIN
IL145372Medicare PIN
IL145247Medicare PIN
IL14S213Medicare PIN
ILR00570Medicare PIN
IL140213Medicare PIN
IL145221Medicare PIN
IL145761Medicare PIN
IL145754Medicare PIN
IL145029Medicare PIN
IL145694Medicare PIN