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General NPI Number Information
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NPI Number | 1679163547
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Entity Type | Organization
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Legal Business Name | COKLOW CONSULTING GROUP, CORP.
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Dates
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Enumeration Date | 01/24/2021
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Last Update Date | 01/24/2021
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Provider Practice Location Address
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Address Line | 5030 N MARINE DR APT 806
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City | CHICAGO
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State | IL
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Zip | 60640-3372
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Country | US
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Telephone | 773-597-7698
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Fax |
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Provider Business Mailing Address
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Address Line | 5030 N MARINE DR APT 806
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City | CHICAGO
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State | IL
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Zip | 60640-3372
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Country | US
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Telephone | 773-597-7698
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LAWRENCE NGU
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Credential | MD
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Telephone | 708-250-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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