Healthcare Provider Details

I. General information

NPI: 1316219736
Provider Name (Legal Business Name): ALLZ FAMILY PRACTICE PHYSICIANS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 RYAN PKWY
ALGONQUIN IL
60102-4530
US

IV. Provider business mailing address

350 SURRYSE RD SUITE 100
LAKE ZURICH IL
60047-3217
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-9555
  • Fax: 847-658-2167
Mailing address:
  • Phone: 847-438-2144
  • Fax: 847-719-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042619902
License Number StateIL

VIII. Authorized Official

Name: DR. JOHN KOLB
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 847-438-2144