Healthcare Provider Details

I. General information

NPI: 1922088111
Provider Name (Legal Business Name): MICHAEL Y KO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 1118
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1725 W HARRISON ST STE 1118
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4500
  • Fax: 312-942-2253
Mailing address:
  • Phone: 312-942-4500
  • Fax: 312-942-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36111677
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0067846
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-111677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: