MEDICARE: JOHN W KOLB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1326032632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W KOLB MD

Provider Business Mailing Address
First Line	:	350 SURRYSE RD
Second Line	:	SUITE 100
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2313
Country	:	US
Telephone Number	:	847-438-2144
Fax Number	:	847-438-1597

Provider Business Practice Location Address
First Line	:	350 SURRYSE RD
Second Line	:	SUITE 100
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2313
Country	:	US
Telephone Number	:	847-438-2144
Fax Number	:	847-438-1597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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