MEDICARE: MRS. ELIZABETH PAULINE KOSKAN MS, ATC

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
1	2255A2300X	Athletic Trainer	96001801	IL

General Provider Information

NPI Number	:	1134137698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH PAULINE KOSKAN MS, ATC

Provider Business Mailing Address
First Line	:	1601 S INDIANA AVE
Second Line	:	#313
City	:	CHICAGO
State	:	IL
Zip	:	60616-1391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 S INDIANA AVE
Second Line	:	#313
City	:	CHICAGO
State	:	IL
Zip	:	60616-1391
Country	:	US
Telephone Number	:	312-212-1426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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