Healthcare Provider Details

I. General information

NPI: 1164802443
Provider Name (Legal Business Name): ARETA KOWAL-VERN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RIVERWOODS DR APT 312
MELROSE PARK IL
60160-1613
US

IV. Provider business mailing address

1700 RIVERWOODS DR APT 312
MELROSE PARK IL
60160-1613
US

V. Phone/Fax

Practice location:
  • Phone: 708-344-7626
  • Fax:
Mailing address:
  • Phone: 708-344-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number036.065992
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: