Active NPI
Michael Cosimi, D.M.D., M.S.
- Periodontics
- Herrin, IL
National Provider Identifier
1881754844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 021002240
- Practice address
- 408 Lincoln Dr Ste C
Herrin, IL 62948-3790 - Phone
- (618) 997-2403
- NPI assigned
- Dec 11, 2006
- Last updated
- May 5, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 021002240 | IL | Primary |
Addresses
Primary practice location
408 Lincoln Dr Ste C
Herrin, IL 62948-3790
Mailing address
408 Lincoln Dr Ste C
Herrin, IL 62948-3790
Phone (618) 997-2403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021002240 | IL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651708800000",
"number": "1881754844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 LINCOLN DR STE C",
"city": "HERRIN",
"state": "IL",
"postal_code": "629483790",
"telephone_number": "618-997-2403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 LINCOLN DR STE C",
"city": "HERRIN",
"state": "IL",
"postal_code": "629483790",
"telephone_number": "618-997-2403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSIMI",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.M.D., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2022-05-05",
"certification_date": "2022-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "021002240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Herrin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.