Provider Demographics
NPI:1033907456
Name:GOSIC, MARINA (CCI)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:GOSIC
Suffix:
Gender:
Credentials:CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 N MARINE DR APT 407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3911
Mailing Address - Country:US
Mailing Address - Phone:708-745-0707
Mailing Address - Fax:
Practice Address - Street 1:4950 N MARINE DR APT 407
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3911
Practice Address - Country:US
Practice Address - Phone:708-745-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00057200246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular