MEDICARE: DR. RICHARD ALAN KOHN DDS MS

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	1223E0200X	Endodontics	021-001106	IL

General Provider Information

NPI Number	:	1336315274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALAN KOHN DDS MS

Provider Business Mailing Address
First Line	:	475 W 55TH ST
Second Line	:	SUITE 208
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-3564
Country	:	US
Telephone Number	:	708-579-0488
Fax Number	:	708-579-0611

Provider Business Practice Location Address
First Line	:	475 W 55TH ST
Second Line	:	SUITE 208
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-3564
Country	:	US
Telephone Number	:	708-579-0488
Fax Number	:	708-579-0611

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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