Healthcare Provider Details

I. General information

NPI: 1679163547
Provider Name (Legal Business Name): COKLOW CONSULTING GROUP, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 01/24/2021
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 N MARINE DR APT 806
CHICAGO IL
60640-3372
US

IV. Provider business mailing address

5030 N MARINE DR APT 806
CHICAGO IL
60640-3372
US

V. Phone/Fax

Practice location:
  • Phone: 773-597-7698
  • Fax:
Mailing address:
  • Phone: 773-597-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE NGU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 708-250-8424