MEDICARE: DR. EWA P KOSER DDS

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	1223G0001X	General Practice Dentistry	019024294	IL

General Provider Information

NPI Number	:	1518010669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EWA P KOSER DDS

Provider Business Mailing Address
First Line	:	250 W KENSINGTON RD
Second Line	:	SUITE 2A
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1293
Country	:	US
Telephone Number	:	847-577-5464
Fax Number	:	847-577-5474

Provider Business Practice Location Address
First Line	:	250 W KENSINGTON RD
Second Line	:	SUITE 2A
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1293
Country	:	US
Telephone Number	:	847-577-5464
Fax Number	:	847-577-5474

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

Provider Enumeration Date	:	01/20/2007
Last Update Date	:	07/08/2007

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