Koltun, Douglas

Koltun, Douglas is an individual health care provider with primary practice located at 4400 W 95Th St Ste 306 , Oak Lawn IL 60453-2659. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Koltun, Douglas can be contacted via phone (708) 684-5428.

Contact Information

Primary practice address
4400 W 95Th St Ste 306 Oak Lawn IL 60453-2659
Phone: (708) 684-5428
Fax: (708) 684-2079
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 036070752 Illinois

Profile Details

NPI number 1326034828
LBN Legal business name Koltun, Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2005
Last updated Dec 15th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326034828 NPPES
Illinois MEDICAID 036070752
Illinois Other 36354817305
Illinois Other 250002469
Illinois Other 01621490
Illinois Other 131667300
Illinois Other 47614

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