Healthcare Provider Details

I. General information

NPI: 1396844189
Provider Name (Legal Business Name): JEAN MARIE KOLB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501A S TOWANDA BARNES RD STE 2
BLOOMINGTON IL
61705-4031
US

IV. Provider business mailing address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

V. Phone/Fax

Practice location:
  • Phone: 309-612-9002
  • Fax:
Mailing address:
  • Phone: 217-784-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-104542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: