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General NPI Number Information
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NPI Number | 1417105917
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Entity Type | Organization
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Legal Business Name | DOLAR R KOYA MD SC
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 2215 THEODORE ST
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City | CRESTHILL
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State | IL
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Zip | 60403
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Country | US
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Telephone | 815-741-2000
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Fax | 815-741-1001
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Provider Business Mailing Address
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Address Line | 2215 THEODORE ST
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City | CREST HILL
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State | IL
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Zip | 60403-5854
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Country | US
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Telephone | 815-741-2000
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Fax | 815-741-1001
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Authorized Official
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Title or Position | OWNER
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Name | DOLAR R KOYA
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Credential | MD
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Telephone | 815-741-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036055698
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License Number State | IL
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