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NPI Code Detail

MEDICARE: KOANY C MO D.O.

MEDICARE: KOANY C MO D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianIL

General Provider Information

NPI Number : 1093895815
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOANY C MO D.O.
Provider Business Mailing Address
First Line : LBX 809274, PO BOX 809274
Second Line :
City : CHICAGO
State : IL
Zip : 60680-9274
Country : US
Telephone Number : 773-445-9696
Fax Number : 773-445-9590
Provider Business Practice Location Address
First Line : 60 E DELAWARE PL
Second Line : 15TH FL
City : CHICAGO
State : IL
Zip : 60611-1495
Country : US
Telephone Number : 312-440-5150
Fax Number : 312-440-5151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 07/09/2007

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Directions to “ KOANY C MO D.O.” Practice Location

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