Healthcare Provider Details

I. General information

NPI: 1003954066
Provider Name (Legal Business Name): ROBERT G KOHN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 RIDGEVIEW DR
MCHENRY IL
60050-7012
US

IV. Provider business mailing address

5404 W ELM ST STE Q
MCHENRY IL
60050-4007
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-7951
  • Fax: 815-759-3807
Mailing address:
  • Phone: 815-344-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-083810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: