Healthcare Provider Details

I. General information

NPI: 1316140452
Provider Name (Legal Business Name): PAUL WILLIAM KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W HIGHWAY 22
BARRINGTON IL
60010-1919
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-9600
  • Fax: 847-967-8594
Mailing address:
  • Phone: 312-316-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.123005
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: