Healthcare Provider Details

I. General information

NPI: 1245483908
Provider Name (Legal Business Name): MR. ANTHONY R KOEBLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N RANDALL RD SUITE 103
ELGIN IL
60123-2306
US

IV. Provider business mailing address

1435 N RANDALL RD SUITE 103
ELGIN IL
60123-2306
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-0750
  • Fax: 847-888-2152
Mailing address:
  • Phone: 847-888-0750
  • Fax: 847-888-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: