Healthcare Provider Details

I. General information

NPI: 1184538076
Provider Name (Legal Business Name): HALEY KOERTING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR
HARVEY IL
60426-3558
US

IV. Provider business mailing address

10490 CARRIAGE TRL
CINCINNATI OH
45242-4539
US

V. Phone/Fax

Practice location:
  • Phone: 708-333-2300
  • Fax:
Mailing address:
  • Phone: 513-316-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.012349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: