Provider Demographics
NPI:1912794405
Name:MATTHEW J KOSCICA MD PLLC
Entity type:Organization
Organization Name:MATTHEW J KOSCICA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOSCICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-600-7818
Mailing Address - Street 1:25 E WASHINGTON ST STE 1464
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1820
Mailing Address - Country:US
Mailing Address - Phone:312-600-7818
Mailing Address - Fax:765-204-1880
Practice Address - Street 1:25 E WASHINGTON ST STE 1464
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1820
Practice Address - Country:US
Practice Address - Phone:312-600-7818
Practice Address - Fax:765-204-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty