Healthcare Provider Details

I. General information

NPI: 1780111534
Provider Name (Legal Business Name): JOSEPH MICHAEL KOES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST 10TH FLOOR
CHICAGO IL
60612-9985
US

IV. Provider business mailing address

1900 W POLK ST 10TH FLOOR
CHICAGO IL
60612-9985
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-0065
  • Fax: 312-864-9656
Mailing address:
  • Phone: 312-864-0065
  • Fax: 312-864-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125070785
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: