Healthcare Provider Details

I. General information

NPI: 1861973273
Provider Name (Legal Business Name): COLIN DOWLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W OGDEN AVE
CHICAGO IL
60612-3773
US

IV. Provider business mailing address

1164 W MADISON ST UNIT 311
CHICAGO IL
60607-3867
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125073429
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: