Healthcare Provider Details

I. General information

NPI: 1518278977
Provider Name (Legal Business Name): KOSHA KAMANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 PARK AVE W
HIGHLAND PARK IL
60035
US

IV. Provider business mailing address

777 PARK AVE W
HIGHLAND PARK IL
60035-2433
US

V. Phone/Fax

Practice location:
  • Phone: 847-926-5840
  • Fax: 847-926-5835
Mailing address:
  • Phone: 847-926-5840
  • Fax: 847-926-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036129352
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036129352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: