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NPI Code Detail

MEDICARE: DR. JEAN MARIE KOLB M.D.

MEDICARE: DR. JEAN MARIE KOLB M.D.
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
1208000000XPediatrics Physician036-104542IL

General Provider Information

NPI Number : 1396844189
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEAN MARIE KOLB M.D.
Provider Business Mailing Address
First Line : 1120 N MELVIN ST
Second Line :
City : GIBSON CITY
State : IL
Zip : 60936-1477
Country : US
Telephone Number : 217-784-4251
Fax Number :
Provider Business Practice Location Address
First Line : 501A S TOWANDA BARNES RD STE 2
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61705-4031
Country : US
Telephone Number : 309-612-9002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 09/23/2025

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