Healthcare Provider Details

I. General information

NPI: 1922416197
Provider Name (Legal Business Name): KODO CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S JOHN ST UNIT 2
DWIGHT IL
60420-1413
US

IV. Provider business mailing address

105 S JOHN ST UNIT 2
DWIGHT IL
60420-1413
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-4722
  • Fax: 815-727-4731
Mailing address:
  • Phone: 815-727-4722
  • Fax: 815-727-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054-018457
License Number StateIL

VIII. Authorized Official

Name: STEVEN QUIGLEY
Title or Position: BILLING MANAGER
Credential:
Phone: 815-727-4722