Healthcare Provider Details

I. General information

NPI: 1871671131
Provider Name (Legal Business Name): LARRRY COWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E 40TH ST
CHICAGO IL
60653-2521
US

IV. Provider business mailing address

906 E 40TH ST
CHICAGO IL
60653-2521
US

V. Phone/Fax

Practice location:
  • Phone: 773-548-5137
  • Fax:
Mailing address:
  • Phone: 773-548-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: