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General NPI Number Information
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NPI Number | 1538168786
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Entity Type | Individual
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Provider Name | EDWARD H. KOLB M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 501A S TOWANDA BARNES RD STE 2
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City | BLOOMINGTON
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State | IL
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Zip | 61705-4031
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Country | US
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Telephone | 309-612-9002
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Fax | 309-391-0134
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Provider Business Mailing Address
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Address Line | 1120 N MELVIN ST
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City | GIBSON CITY
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State | IL
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Zip | 60936-1477
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Country | US
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Telephone | 217-784-4251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036-108279
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License Number State | IL
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