Nathaniel Koo, | |
840 S Wood St, Suite 518-e, Chicago, IL 60612-4325 | |
(312) 996-6765 | |
Not Available |
Full Name | Nathaniel Koo |
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Gender | Male |
Speciality | Surgery - Pediatric Surgery |
Location | 840 S Wood St, Chicago, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1467626184 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2086S0120X | Surgery - Pediatric Surgery | 036133774 (Illinois) | Primary |
208600000X | Surgery | 036133774 (Illinois) | Secondary |
Entity Name | Bonaventure Medical Foundation Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1588775647 PECOS PAC ID: 7517863178 Enrollment ID: O20031212000374 |
Entity Name | Rush University Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1093819542 PECOS PAC ID: 5496658874 Enrollment ID: O20040202000228 |
Entity Name | Northshore University Healthsystem Faculty Practice Associates |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1497701882 PECOS PAC ID: 2163334699 Enrollment ID: O20040524000118 |
Entity Name | Shriners Hospitals For Children |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1871930693 PECOS PAC ID: 9133031933 Enrollment ID: O20131009001351 |
Mailing Address | Practice Location Address |
---|---|
Nathaniel Koo, 1012 N Wood St Unit 2, Chicago, IL 60622-3261 Ph: (847) 903-7507 | Nathaniel Koo, 840 S Wood St, Suite 518-e, Chicago, IL 60612-4325 Ph: (312) 996-6765 |
Raelene D Kennedy, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1725 W Harrison St Ste 810, Chicago, IL 60612 Phone: 312-942-5500 | |
Douglas Wiseman, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 7447 W Talcott Ave Ste 427, Chicago, IL 60631 Phone: 773-990-4024 | |
Dr. Bobiejo Ava Ferguson Bryan, MD Surgery Medicare: Medicare Enrolled Practice Location: 5841 S Maryland Ave # Mc6040, Chicago, IL 60637 Phone: 773-702-1000 Fax: 773-702-2140 | |
Adam Lam, MD Surgery Medicare: Medicare Enrolled Practice Location: 5841 S Maryland Ave # Mc6040, Chicago, IL 60637 Phone: 773-702-1000 Fax: 773-702-2140 | |
Kabeer Rajan Masih, MD Surgery Medicare: Medicare Enrolled Practice Location: 1620 W Harrison St, Chicago, IL 60612 Phone: 312-942-5000 | |
Jay Prystowsky, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 680 N Lake Shore Dr, Suite 1000, Chicago, IL 60611 Phone: 312-695-9797 | |
Heron Rodriguez, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 675 N Saint Clair St, Northwestern Memorial Hospialt Galter 19-100, Chicago, IL 60611 Phone: 312-695-2714 |