MEDICARE: LARRRY COWAN

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	227800000X	Certified Respiratory Therapist		IL

General Provider Information

NPI Number	:	1871671131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRRY COWAN

Provider Business Mailing Address
First Line	:	906 E 40TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-2521
Country	:	US
Telephone Number	:	773-548-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 E 40TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-2521
Country	:	US
Telephone Number	:	773-548-5137
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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Directions to “ LARRRY COWAN ” Practice Location

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