MEDICARE: BRUCE KOLTON MD LLC

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	207N00000X	Dermatology Physician		IL

Other Identifiers

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

General Provider Information

NPI Number	:	1861666299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE KOLTON MD LLC

Provider Business Mailing Address
First Line	:	21421 NETWORK PLACE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-0001
Country	:	US
Telephone Number	:	847-839-9999
Fax Number	:	847-885-1111

Provider Business Practice Location Address
First Line	:	2500 W HIGGINS RD STE 940
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-2085
Country	:	US
Telephone Number	:	847-839-9999
Fax Number	:	847-885-1111

Authorized Official
Title or Position	:	PARTNER
Name	:	BRUCE KOLTON
Credential	:	MD
Telephone Number	:	847-839-9999

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/20/2008

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