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NPI Code Detail

MEDICARE: MR. BRUCE KOLTON M.D.

MEDICARE:  MR. BRUCE  KOLTON  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
1207N00000XDermatology Physician036047580IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457354334
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE KOLTON M.D.
Provider Business Mailing Address
First Line : 160 GREENBRIAR DR
Second Line :
City : DEERFIELD
State : IL
Zip : 60015-5024
Country : US
Telephone Number : 847-945-0773
Fax Number : 847-945-0776
Provider Business Practice Location Address
First Line : 2500 W HIGGINS RD
Second Line : STE 940
City : HOFFMAN ESTATES
State : IL
Zip : 60195-2085
Country : US
Telephone Number : 847-839-9999
Fax Number : 847-885-1111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 01/05/2012

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Directions to “ MR. BRUCE KOLTON M.D.” Practice Location

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