MEDICARE: DR. COLIN COUBAL

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	207R00000X	Internal Medicine Physician	125.087222	IL

General Provider Information

NPI Number	:	1780529495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLIN COUBAL

Provider Business Mailing Address
First Line	:	5140 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3645
Country	:	US
Telephone Number	:	715-563-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 W CRYSTAL ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3660
Country	:	US
Telephone Number	:	715-563-7635
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ DR. COLIN COUBAL ” Practice Location

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